1
|
Vos JAM, Wollersheim BM, Cooke A, Ee C, Chan RJ, Nekhlyudov L. Primary care physicians' knowledge and confidence in providing cancer survivorship care: a systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01397-y. [PMID: 37171716 DOI: 10.1007/s11764-023-01397-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE To systematically review existing literature on knowledge and confidence of primary care physicians (PCPs) in cancer survivorship care. METHODS PubMed, Ovid MEDLINE, CINAHL, Embase, and PsycINFO were searched from inception to July 2022 for quantitative and qualitative studies. Two reviewers independently assessed studies for eligibility and quality. Outcomes were characterized by domains of quality cancer survivorship care. RESULTS Thirty-three papers were included, representing 28 unique studies; 22 cross-sectional surveys, 8 qualitative, and 3 mixed-methods studies. Most studies were conducted in North America (n = 23) and Europe (n = 8). For surveys, sample sizes ranged between 29 and 1124 PCPs. Knowledge and confidence in management of physical (n = 19) and psychosocial effects (n = 12), and surveillance for recurrences (n = 14) were described most often. Generally, a greater proportion of PCPs reported confidence in managing psychosocial effects (24-47% of PCPs, n= 5 studies) than physical effects (10-37%, n = 8). PCPs generally thought they had the necessary knowledge to detect recurrences (62-78%, n = 5), but reported limited confidence to do so (6-40%, n = 5). There was a commonly perceived need for education on long-term and late physical effects (n = 6), and cancer surveillance guidelines (n = 9). CONCLUSIONS PCPs' knowledge and confidence in cancer survivorship care varies across care domains. Suboptimal outcomes were identified in managing physical effects and recurrences after cancer. IMPLICATIONS FOR CANCER SURVIVORS These results provide insights into the potential role of PCPs in cancer survivorship care, medical education, and development of targeted interventions.
Collapse
Affiliation(s)
- Julien A M Vos
- Department of General Practice, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health, research programme Quality of Care, and Personalized Medicine, Amsterdam, the Netherlands.
| | - Barbara M Wollersheim
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Adelaide Cooke
- MS1 at University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South, Adelaide, Australia
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Recovery of Health and Wellbeing in Rural Cancer Survivors Following Primary Treatment: Analysis of UK Qualitative Interview Data. NURSING REPORTS 2022; 12:482-497. [PMID: 35894036 PMCID: PMC9326683 DOI: 10.3390/nursrep12030046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/25/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose: Rural cancer survivors have poorer experiences and health outcomes compared to their urban counterparts. There is limited research on the post-treatment experiences of UK cancer survivors residing in rural areas. This study aimed to provide an understanding of the specific challenges and opportunities faced by rural cancer survivors and to provide insight into how rurality influences experiences post-primary treatment, ultimately to inform service provision. Methods: A secondary analysis of in-depth interview transcripts (n = 16) from a wider study on self-management in cancer survivors was conducted. An adapted version of Foster and Fenlon’s recovery of health and wellbeing in cancer survivorship framework informed the data coding. Results: Health and wellbeing were interrupted by a variety of problem incidents, and the subsequent steps to recovery were influenced by pre-existing, personal, environmental, and healthcare factors. A prominent theme was support, both from local communities and family as well as from healthcare professionals, with many survivors feeling that their rural setting had a positive influence on their health and wellbeing. Close relationships with local GPs were seen as fundamental to supporting recovery. Access to healthcare was frequently mentioned as a challenge with an emphasis on lengthy travel times and limited bespoke support in rural areas. Conclusions: This study is novel in that it applied a well-established theoretical framework to a rich qualitative dataset on the lived experiences of rural cancer survivors. Rural residency influenced recovery from cancer both positively and negatively. Implications for Cancer Survivors: Future practitioners and policy makers should consider working with local communities to tailor interventions to the specific characteristics of the rural environment.
Collapse
|
3
|
Fox J, Thamm C, Mitchell G, Emery J, Rhee J, Hart NH, Yates P, Jefford M, Koczwara B, Halcomb E, Steinhardt R, O'Reilly R, Chan RJ. Cancer survivorship care and general practice: A qualitative study of roles of general practice team members in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1415-e1426. [PMID: 34423502 DOI: 10.1111/hsc.13549] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/30/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
Primary care providers, including general practice teams (GPTs), are well positioned within the community to integrate cancer survivorship care into ongoing health management. However, roles of GPT members in delivery of cancer survivorship care have not been explored. The purpose of this study is to explore these roles from the perspectives of General Practitioners (GPs), Practice Nurses (PNs) and Practice Managers (PMs). An interpretive qualitative study using semi-structured in-depth telephone interviews with ten GPs, nine PNs and five PMs was conducted. Interviews were recorded, transcribed and analysed using grounded theory methods. Perspectives of roles in delivery of cancer survivorship care were highly variable. Variation was evident among perceptions of needs of cancer survivors, individual team members' scopes of practice, and individual professional knowledge and skills. A lack of clarity in roles and responsibilities of GPT members was thought to contribute to a lack of consistency in survivorship care. Reducing variations in perceptions of survivorship care in the primary care setting should be a priority. Such efforts may include development of practical guidance to support GPT members to clarify scopes of practice within the team. In addition to accessible comprehensive education programs, other innovative, tailored individualised education approaches may be helpful. System-level support in clarifying and supporting the roles of the primary care team is needed to facilitate a survivorship delivery system at general practice level where those within GPT can ensure that individual patients' needs are met in a timely and effective manner.
Collapse
Affiliation(s)
- Jennifer Fox
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
| | - Carla Thamm
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
| | - Geoff Mitchell
- Limestone Medical Centre, Ipswich, Qld, Australia
- Primary Care Clinical Unit, University of Queensland, Herston, Qld, Australia
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, The University of Melbourne, Melbourne, Vic., Australia
| | - Joel Rhee
- General Practice Academic Unit, School of Medicine, The University of Wollongong, Wollongong, NSW, Australia
| | - Nicolas H Hart
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA, Australia
- East Brunswick Medical Centre, Brunswick, Vic., Australia
| | - Patsy Yates
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., Australia
| | - Bogda Koczwara
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Medical Centre, Adelaide, SA, Australia
| | - Elizabeth Halcomb
- School of Nursing, Midwifery and Indigenous Health, The University of Wollongong, Wollongong, NSW, Australia
| | | | - Roslyn O'Reilly
- School of Nursing, Midwifery and Indigenous Health, The University of Wollongong, Wollongong, NSW, Australia
| | - Raymond J Chan
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA, Australia
- East Brunswick Medical Centre, Brunswick, Vic., Australia
| |
Collapse
|
4
|
Specialist versus Primary Care Prostate Cancer Follow-Up: A Process Evaluation of a Randomized Controlled Trial. Cancers (Basel) 2022; 14:cancers14133166. [PMID: 35804937 PMCID: PMC9264897 DOI: 10.3390/cancers14133166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Worldwide, there is an increased focus on reorganizing prostate cancer survivorship care. In this study, we describe for the first time a process evaluation as part of a randomized controlled trial that is currently comparing the effectiveness of specialist- versus primary care-based prostate cancer follow-up. We found that within an RCT context, 67% patients and their GPs were willing to receive/provide primary care-based follow-up. Patients who received primary care-based follow-up care experienced this to be more personal, efficient, and sustainable. However, patients, GPs, and specialists also indicated several challenges that are described in this study and should be addressed to enable a smooth transition of prostate cancer follow-up to primary care. Abstract Background: A randomized controlled trial (RCT) is currently comparing the effectiveness of specialist- versus primary care-based prostate cancer follow-up. This process evaluation assesses the reach and identified constructs for the implementation of primary care-based follow-up. Methods: A mixed-methods approach is used to assess the reach and the implementation through the Consolidated Framework for Implementation Research. We use quantitative data to evaluate the reach of the RCT and qualitative data (interviews) to indicate the perspectives of patients (n = 15), general practitioners (GPs) (n = 10), and specialists (n = 8). Thematic analysis is used to analyze the interview transcripts. Results: In total, we reached 402 (67%) patients from 12 hospitals and randomized them to specialist- (n = 201) or to primary care-based (n = 201) follow-up. From the interviews, we identify several advantages of primary care- versus specialist-based follow-up: it is closer to home, more accessible, and the relationship is more personal. Nevertheless, participants also identified challenges: guidelines should be implemented, communication and collaboration between primary and secondary care should be improved, quality indicators should be collected, and GPs should be compensated. Conclusion: Within an RCT context, 402 (67%) patients and their GPs were willing to receive/provide primary care-based follow-up. If the RCT shows that primary care is equally as effective as specialist-based follow-up, the challenges identified in this study need to be addressed to enable a smooth transition of prostate cancer follow-up to primary care.
Collapse
|
6
|
Nicolaisen A, Lauridsen GB, Haastrup P, Hansen DG, Jarbøl DE. Healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective: a scoping review. Scand J Prim Health Care 2022; 40:11-28. [PMID: 35254205 PMCID: PMC9090364 DOI: 10.1080/02813432.2022.2036421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE General practice plays an important role in cancer trajectories, and cancer patients request the continuous involvement of general practice. The objective of this scoping review was to identify healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective. DESIGN, SETTING, AND SUBJECTS A scoping review of the literature published in Danish or English from 2010 to 2020 was conducted. Data was collected using identified keywords and indexed terms in several databases (PubMed, MEDLINE, EBSCO CINAHL, Scopus, and ProQuest), contacting key experts, searching through reference lists, and reports from selected health political, research- and interest organizations' websites. MAIN OUTCOME MEASURES We identified healthcare practices in cancer trajectories that increase quality care. Identified healthcare practices were grouped into four contextual domains and allocated to defined phases in the cancer trajectory. The results are presented according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR). RESULTS A total of 45 peer-reviewed and six non-peer-reviewed articles and reports were included. Quality of care increases in all phases of the cancer trajectory when GPs listen carefully to the full story and use action plans. After diagnosis, quality of care increases when GPs and practice staff have a proactive care approach, act as interpreters of diagnosis, treatment options, and its consequences, and engage in care coordination with specialists in secondary care involving the patient. CONCLUSION This scoping review identified healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective. The results support general practice in investigating own healthcare practices and identifying possibilities for quality improvement.KEY POINTSIdentified healthcare practices in general practice that increase the quality of care in cancer trajectories:Listen carefully to the full storyUse action plans and time-out-consultationsPlan and provide proactive careAct as an interpreter of diagnosis, treatment options, and its consequences for the patientCoordinate care with specialists, patients, and caregivers with mutual respectIdentified barriers for quality of care in cancer trajectories are:Time constraints in consultationsLimited accessibility for patients and caregiversHealth practices to increase the quality of care should be effective, safe, people-centered, timely, equitable, integrated, and efficient. These distinctions of quality of care, support general practice in investigating and improving quality of care in cancer trajectories.
Collapse
Affiliation(s)
- Anne Nicolaisen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- CONTACT Anne Nicolaisen Research Unit for General Practice, Department of Public Health, University of Southern Denmark, DK-5000Odense C, Denmark
| | - Gitte Bruun Lauridsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Peter Haastrup
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Dorte Gilså Hansen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- The Department of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| |
Collapse
|