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Fasting A, Hetlevik I, Mjølstad BP. Put on the sidelines of palliative care: a qualitative study of important barriers to GPs' participation in palliative care and guideline implementation in Norway. Scand J Prim Health Care 2024; 42:254-265. [PMID: 38289262 PMCID: PMC11003325 DOI: 10.1080/02813432.2024.2306241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/11/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Demographic changes, the evolvement of modern medicine and new treatments for severe diseases, increase the need for palliative care services. Palliative care includes all patients with life-limiting conditions, irrespective of diagnosis. In Norway, palliative care rests on a decentralised model where patient care can be delivered close to the patient's home, and the Norwegian guideline for palliative care describes a model of care resting on extensive collaboration. Previous research suggests that this guideline is not well implemented among general practitioners (GPs). In this study, we aim to investigate barriers to GPs' participation in palliative care and implementation of the guideline. METHODS We interviewed 25 GPs in four focus groups guided by a semi-structured interview guide. The interviews were recorded and transcribed verbatim. Data were analysed qualitatively with reflexive thematic analysis. RESULTS We identified four main themes as barriers to GPs' participation in palliative care and to implementation of the guideline: (1) different established local cultures and practices of palliative care, (2) discontinuity of the GP-patient relationship, (3) unclear clinical handover and information gaps and (4) a mismatch between the guideline and everyday general practice. CONCLUSION Significant structural and individual barriers to GPs' participation in palliative care exist, which hamper the implementation of the guideline. GPs should be involved as stakeholders when guidelines involving them are created. Introduction of new professionals in primary care needs to be actively managed to avoid inappropriate collaborative practices. Continuity of the GP-patient relationship must be maintained throughout severe illness and at end-of-life.
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Affiliation(s)
- Anne Fasting
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Unit for Palliative Care and Chemotherapy Treatment, Oncology Department, Møre og Romsdal Hospital Trust, Kristiansund Hospital, Norway
| | - Irene Hetlevik
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bente Prytz Mjølstad
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Saksvik legekontor, Saxe Viks veg 4, N-7562 Hundhammeren, Norway
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2
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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.
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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
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3
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Kimachi M, Omae K, Kamitani T, Fukuma S. Primary care physicians' perceptions concerning engagement in cancer survivor care. J Gen Fam Med 2021; 23:149-157. [PMID: 35509332 PMCID: PMC9062547 DOI: 10.1002/jgf2.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/19/2021] [Accepted: 12/06/2021] [Indexed: 12/05/2022] Open
Abstract
Background Given the growing diversity among cancer survivors and the fact that oncologists typically do not perform long‐term care, the expected role of primary care physicians (PCPs) in survivor care is expanding. However, communication and collaboration between oncologists and PCPs are lacking. Therefore, we assessed the perception of cancer survivor care among PCPs. Methods We sent a questionnaire to 767 Japanese Board–certified PCPs, regardless of facility type (clinics and hospitals), inquiring about PCPs' perceptions of their role in survivor care. Additionally, we included vignette‐based scenarios focused on colorectal and prostate cancer survivors to explore factors associated with their clinical decisions. Results We obtained 91 replies (response rate: 11.9%). A total of 75% of PCPs had encountered at least 1 cancer patient in actual practice. Even for patients actively receiving cancer treatment, >70% of PCPs reported that they were willing to engage in comprehensive survivor care, except for the administration of anticancer drugs. Further, 49% of PCPs considered that both PCPs and oncologists were suited to performing regular screening for cancer recurrence in high‐risk patients. Multivariable logistic regression analyses revealed that clinic PCPs were less inclined to conduct screening for recurrence than hospital PCPs in both colorectal (odds ratio, 3.85 [95% confidence interval 1.40–10.6]) and prostate (4.36 [95% confidence interval 1.51–12.6]) cancer scenarios. Conclusions Our findings suggest that Japanese PCPs are willing to engage in survivor care and encourage closer collaboration between oncologists and PCPs. However, oncologists might need to request cooperation, considering the facility type with which PCPs are affiliated. The present study revealed that Japanese primary care physicians (PCPs) were willing to engage in comprehensive survivor care, except for the administration of anticancer drugs. Further, most PCPs were willing to engage in psychosocial support to relieve survivors' anxiety and manage work‐related issues, but they have few opportunities to collaborate with oncologists. Oncologists and PCPs need to engage in more communication and conduct cancer survivor care while capitalizing on PCPs' willingness and capability.![]()
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Affiliation(s)
- Miho Kimachi
- Human Health Sciences Kyoto University Graduate School of Medicine Kyoto Japan
| | - Kenji Omae
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT) Fukushima Medical University Fukushima Japan
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
| | - Shingo Fukuma
- Human Health Sciences Kyoto University Graduate School of Medicine Kyoto Japan
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4
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Deckx L, Chow KH, Askew D, van Driel ML, Mitchell GK, van den Akker M. Psychosocial care for cancer survivors: A systematic literature review on the role of general practitioners. Psychooncology 2021; 30:444-454. [PMID: 33314485 DOI: 10.1002/pon.5612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore the general practitioners (GP's) role in providing psychosocial care for cancer survivors through a systematic literature review. METHODS We searched MEDLINE, EMBASE, PsycINFO, and CINAHL and included the studies that complied with the predefined inclusion and exclusion criteria. At least two independent reviewers performed the quality appraisal and data extraction. RESULTS We included 33 (five qualitative, 19 observational, and nine intervention) studies; the majority of these studies focused on care for depression and anxiety (21/33). Cancer survivors were more likely to contact their GP for psychosocial problems compared with noncancer controls. Survivors were more likely to use antidepressants compared with controls, although 71% of survivors preferred depression treatment to be "talking therapy only." Overall, GPs and patients mostly agreed that GPs are the preferred healthcare provider to manage psychosocial problems. The major exception is a survivor's fear of recurrence-here, the oncologist was the preferred healthcare provider. Only two interventions effectively decreased depression or anxiety; these studies included patients who had a clinical indication for psychosocial care, were specifically designed for decreasing depression/anxiety, and consisted of a multidisciplinary team approach. The other interventions evaluated GP-led follow-up for cancer survivors and found that this did not impact the patients' levels of anxiety, depression, or distress neither negatively nor positively. CONCLUSIONS Cancer survivors often prefer psychosocial care by their GP, and GPs generally consider they are well placed to provide this care. Although evidence on the effectiveness of psychosocial care by GPs is limited, an active multidisciplinary team approach seems key.
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Affiliation(s)
- Laura Deckx
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ka Hei Chow
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Deborah Askew
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Geoffrey K Mitchell
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Marjan van den Akker
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany.,Academic Centre for General Practice, KU Leuven, Leuven, Belgium.,Department of General Practice, Maastricht University, Maastricht, The Netherlands
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5
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Raginel T, Grandazzi G, Launoy G, Trocmé M, Christophe V, Berchi C, Guittet L. Social inequalities in cervical cancer screening: a discrete choice experiment among French general practitioners and gynaecologists. BMC Health Serv Res 2020; 20:693. [PMID: 32718319 PMCID: PMC7385880 DOI: 10.1186/s12913-020-05479-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/28/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Cervical cancer screening is effective in reducing mortality due to uterine cervical cancer (UCC). However, inequalities in participation in UCC screening exist, especially according to age and social status. Considering the current situation in France regarding the ongoing organized UCC screening campaign, we aimed to assess general practitioners' (GPs) and gynaecologists' preferences for actions designed to reduce screening inequalities. METHODS French physicians' preferences to UCC screening modalities was assessed using a discrete choice experiment. A national cross-sectional questionnaire was sent between September and October 2014 to 500 randomly selected physicians, and numerically to all targeted physicians working in the French region Midi-Pyrénées. Practitioners were offered 11 binary choices of organized screening scenarios in order to reduce inequalities in UCC screening participation. Each scenario was based on five attributes corresponding to five ways to enhance participation in UCC screening while reducing screening inequalities. RESULTS Among the 123 respondents included, practitioners voted for additional interventions targeting non-screened women overall (p < 0.05), including centralized invitations sent from a central authority and involving the mentioned attending physician, or providing attending physicians with the lists of unscreened women among their patients. However, they rejected the specific targeting of women over 50 years old (p < 0.01) or living in deprived areas (p < 0.05). Only GPs were in favour of allowing nurses to perform Pap smears, but both GPs and gynaecologists rejected self-collected oncogenic papillomavirus testing. CONCLUSIONS French practitioners tended to value the traditional principle of universalism. As well as rejecting self-collected oncogenic papillomavirus testing, their reluctance to support the principle of proportionate universalism relying on additional interventions addressing differences in socioeconomic status needs further evaluation. As these two concepts have already been recommended as secondary development leads for the French national organized screening campaign currently being implemented, the adherence of practitioners and the adaptation of these concepts are necessary conditions for reducing inequalities in health care.
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Affiliation(s)
- Thibaut Raginel
- NORMANDIE UNIV, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
- NORMANDIE UNIV, UNICAEN, UFR Sante, Department of General Practice, 14000 Caen, France
| | | | - Guy Launoy
- NORMANDIE UNIV, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
| | - Mélanie Trocmé
- Univ. Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | - Véronique Christophe
- Univ. Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | - Célia Berchi
- NORMANDIE UNIV, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
| | - Lydia Guittet
- NORMANDIE UNIV, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
- Caen University Hospital, Département d’Information Médicale, Avenue de la Côte de Nacre, 14033 Caen, France
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6
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van Leeuwen A, Wind J, van Weert H, de Wolff V, van Asselt K. Experiences of general practitioners participating in oncology meetings with specialists to support GP-led survivorship care; an interview study from the Netherlands. Eur J Gen Pract 2019; 24:171-176. [PMID: 29952234 PMCID: PMC6032010 DOI: 10.1080/13814788.2018.1478960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Due to ageing, increasing cancer incidence and improved treatment, the number of survivors of cancer increases. To overcome the growing demand for hospital care survivorship by the involvement of the general practitioner (GP) has been suggested. Dutch GPs started a project to offer survivorship care to their patients with the help of monthly oncology meetings with hospital specialists. Objectives: To evaluate the experiences of GPs with monthly oncology meetings in a GP-practice to support GP-led survivorship care of colon cancer patients. Methods: This is a qualitative study in primary care centres in a region in the Netherlands around one hospital. GPs were recruited from practices organizing monthly oncology meetings with hospital specialists. Ten of 15 participating GPs were interviewed until saturation. The interviews were transcribed verbatim and two independent researchers analysed the data. Results: The oncology meetings and individual care plans attributed to a feeling of shared responsibility for the patients by the GP and the specialist. The meetings helped the GPs to be informed about the patients in the diagnostic and treatment phase, which was followed by a clear moment of transfer from hospital to primary care. GPs were better equipped to treat comorbidity and were more confident in providing survivorship care. Due to lack of reimbursement for survivorship care, the internal motivation of the GP must high. Conclusion: The oncology meetings fulfil the need for information and communication. Close cooperation between GPs and oncology specialists appears to be an essential factor for GPs to value GP-led survivorship care positively.
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Affiliation(s)
- Anne van Leeuwen
- a Department of General Practice , Academic Medical Centre, University of Amsterdam , Amsterdam , The Netherlands
| | - Jan Wind
- a Department of General Practice , Academic Medical Centre, University of Amsterdam , Amsterdam , The Netherlands
| | - Henk van Weert
- a Department of General Practice , Academic Medical Centre, University of Amsterdam , Amsterdam , The Netherlands
| | | | - Kristel van Asselt
- a Department of General Practice , Academic Medical Centre, University of Amsterdam , Amsterdam , The Netherlands
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7
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Assessment for hierarchical medical policy proposals using hesitant fuzzy linguistic analytic network process. Knowl Based Syst 2018. [DOI: 10.1016/j.knosys.2018.07.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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de Jong F, Frings-Dresen MH, Dijk NV, van Etten-Jamaludin FS, van Asselt KM, de Boer AGEM. The role of the general practitioner in return to work after cancer-a systematic review. Fam Pract 2018; 35:531-541. [PMID: 29420712 DOI: 10.1093/fampra/cmx114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The number of cancer patients and survivors of working age is increasing. General Practitioners (GPs) may have a significant role in psychosocial cancer care, including work-related concerns. Therefore, we performed a systematic literature review to identify the role of the GP in work-related concerns and integration/reintegration into work of cancer patients and/or survivors. METHODS We searched PubMed, Embase, Cinahl, PsycINFO and Cochrane Library, irrespective of study design. We found 4863 articles and, after removing duplicates, we screened 3388 articles by title and abstract and reviewed 66 of these in full text. The Critical Appraisal Skills Programme tool was used to assess the methodological quality of included articles. We used narrative synthesis to describe the role of the GP. RESULTS We included four qualitative studies from three countries. Two of these studies focused on the health care professionals' perspectives and two studies focused on patients' perspectives regarding the role of the GP. Lack of communication between health care professionals, lack of knowledge about work-related concerns and limited resources were recurring themes in these papers. Fully establishing the role of the GP is difficult given the small number of studies on work-related concerns in cancer patients in primary care. CONCLUSION There is little evidence regarding the role of the general practitioner in cancer care and work guidance. Therefore, further research should focus on the role that is desired for GPs and on interventions to study the feasibility of GP involvement in the return to work of cancer patients and/or survivors.
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Affiliation(s)
- Femke de Jong
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands.,Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Monique H Frings-Dresen
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Nynke van Dijk
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | | | - Kristel M van Asselt
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Angela G E M de Boer
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
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9
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Tilburgs B, Vernooij-Dassen M, Koopmans R, van Gennip H, Engels Y, Perry M. Barriers and facilitators for GPs in dementia advance care planning: A systematic integrative review. PLoS One 2018; 13:e0198535. [PMID: 29924837 PMCID: PMC6010277 DOI: 10.1371/journal.pone.0198535] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 05/21/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Due to the disease's progressive nature, advance care planning (ACP) is recommended for people with early stage dementia. General practitioners (GPs) should initiate ACP because of their longstanding relationships with their patients and their early involvement with the disease, however ACP is seldom applied. AIM To determine the barriers and facilitators faced by GPs related to ACP with people with dementia. DATA SOURCES We systematically searched the relevant databases for papers published between January 1995 and December 2016, using the terms: primary healthcare, GP, dementia, and ACP. We conducted a systematic integrative review following Whittemore and Knafl's method. Papers containing empirical data about GP barriers and/or facilitators regarding ACP for people with dementia were included. We evaluated quality using the Mixed-Method-Appraisal-Tool and analyzed data using qualitative content analysis. RESULTS Ten qualitative, five quantitative, and one mixed-method paper revealed four themes: timely initiation of ACP, stakeholder engagement, important aspects of ACP the conversation, and prerequisites for ACP. Important barriers were: uncertainty about the timing of ACP, how to plan for an uncertain future, lack of knowledge about dementia, difficulties assessing people with dementia's decisional capacities, and changing preferences. Facilitators for ACP were: an early start when cognitive decline is still mild, inclusion of all stakeholders, and discussing social and medical issues aimed at maintaining normal life. CONCLUSION Discussing future care is difficult due to uncertainties about the future and the decisional capacities of people with dementia. Based on the facilitators, we recommend that GPs use a timely and goal-oriented approach and involve all stakeholders. ACP discussions should focus on the ability of people with dementia to maintain normal daily function as well as on their quality of life, instead of end-of-life-discussions only. GPs need training to acquire knowledge and skills to timely initiate collaborative ACP discussions.
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Affiliation(s)
- Bram Tilburgs
- Department of IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
| | | | - Raymond Koopmans
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
- Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
- Joachim and Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Hans van Gennip
- Independent Educational Researcher, Family carer, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Marieke Perry
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
- Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
- Department of Geriatric Medicine, Radboudumc, Nijmegen, The Netherlands
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10
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Pype P, Mertens F, Belche J, Duchesnes C, Kohn L, Sercu M, Deveugele M. Experiences of hospital-based multidisciplinary team meetings in oncology: An interview study among participating general practitioners. Eur J Gen Pract 2018; 23:155-163. [PMID: 28554220 PMCID: PMC5774280 DOI: 10.1080/13814788.2017.1323081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Cancer care has become complex, requiring healthcare professionals to collaborate to provide high-quality care. Multidisciplinary oncological team (MDT) meetings in the hospital have been implemented to coordinate individual cancer patients’ care. General practitioners (GPs) are invited to join, but their participation is minimal. Objectives: Aim of this study is to explore participating GPs’ perceptions of their current role and to understand their preferences towards effective role execution during MDT meetings. Methods: In May to June 2014, semi-structured interviews (n = 16) were conducted involving GPs with MDT experience in Belgium. The analysis was done according to qualitative content analysis principles. Results: Attendance of an MDT meeting is perceived as part of the GP’s work, especially for complex patient care situations. Interprofessional collaborative relationships and the GP’s perceived benefit to the MDT meeting discussions are important motivators to participate. Enhanced continuity of information flow and optimized organizational time management were practical aspects triggering the GP’s intention to participate. GPs valued the communication with the patient before and after the meeting as an integral part of the MDT dynamics. Conclusion: GPs perceive attendance of the MDT meeting as an integral part of their job. Suggestions are made to enhance the efficiency of the meetings.
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Affiliation(s)
- Peter Pype
- a Department of Family Medicine and Primary Healthcare , Ghent University , Ghent , Belgium
| | - Fien Mertens
- a Department of Family Medicine and Primary Healthcare , Ghent University , Ghent , Belgium
| | - Jeanluc Belche
- b Département Universitaire de Médecine Générale, Faculté de Médecine , Université de Liège , Liege , Belgium
| | - Christiane Duchesnes
- b Département Universitaire de Médecine Générale, Faculté de Médecine , Université de Liège , Liege , Belgium
| | - Laurence Kohn
- c Belgian Health Care Knowledge Centre (KCE) , Brussels , Belgium
| | - Marij Sercu
- a Department of Family Medicine and Primary Healthcare , Ghent University , Ghent , Belgium
| | - Myriam Deveugele
- a Department of Family Medicine and Primary Healthcare , Ghent University , Ghent , Belgium
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11
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Verger P, Bocquier A, Bournot MC, Buyck JF, Carrier H, Chaput H, Giraud J, Hérault T, Filippi S, Marbot C, Rey D, Tallec A, Zaytseva A, Ventelou B. Le panel de médecins généralistes de ville : éclairages sur les enjeux de la médecine de premier recours d’aujourd’hui. ACTA ACUST UNITED AC 2017. [DOI: 10.3917/rfas.173.0213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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12
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Vrijmoeth C, Barten P, Assendelft WJJ, Christians MGM, Festen DAM, Tonino M, Vissers KCP, Groot M. Physicians' identification of the need for palliative care in people with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 59:55-64. [PMID: 27501524 DOI: 10.1016/j.ridd.2016.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND A growing number of people with intellectual disabilities (ID) is suffering from life-threatening chronic illnesses and is therefore in need for palliative care. AIMS We aimed to explore how the need for palliative care is recognized in people with ID. METHODS AND PROCEDURES We conducted a semi-structured interview study among 10 ID-physicians in the Netherlands. OUTCOMES AND RESULTS Identification of people with ID in need for palliative care mostly results from a process in which multiple signals from different information sources converge and lead to a growing awareness. As a result, ID-physicians do not expect people to return to their prior level of health or functioning, but rather expect an irreversible decline leading to death. The presence, stage and prognosis of the disease, physician-patient interaction, and communication with proxies who provide contextual information are factors influencing the process. CONCLUSIONS AND IMPLICATIONS Distinctive for a population of people with ID are the frequent diagnostic uncertainty in people with ID, the patients' communicational abilities and the reliance of ID-physicians on close proxies. We argue for a proactive attitude of physicians regarding care and support of people with ID with palliative care needs.
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Affiliation(s)
- Cis Vrijmoeth
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboudumc Nijmegen, PO box 9101 (route 68), 6500 HB Nijmegen, The Netherlands; Intellectual Disability Medicine, Department of General Practice, Erasmus MC Rotterdam, PO Box 2040 (NA 1909), 3000 CA Rotterdam, The Netherlands.
| | - Pleun Barten
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboudumc Nijmegen, PO box 9101 (route 68), 6500 HB Nijmegen, The Netherlands.
| | - Willem J J Assendelft
- Department of Primary and Community Health Care, Radboudumc Nijmegen, PO box 9101 (route 117), 6500 HB Nijmegen, The Netherlands.
| | - Milou G M Christians
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboudumc Nijmegen, PO box 9101 (route 68), 6500 HB Nijmegen, The Netherlands.
| | - Dederieke A M Festen
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC Rotterdam, PO Box 2040 (NA 1909), 3000 CA Rotterdam, The Netherlands.
| | - Marijke Tonino
- Prisma Foundation Biezenmortel, Hooghoutseweg 3, 5074 NA Biezenmortel, The Netherlands.
| | - Kris C P Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc Nijmegen, PO box 9101 (route 549), 6500 HB Nijmegen, The Netherlands.
| | - Marieke Groot
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc Nijmegen, PO box 9101 (route 549), 6500 HB Nijmegen, The Netherlands.
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13
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Primary Care Physicians' Perspectives of Their Role in Cancer Care: A Systematic Review. J Gen Intern Med 2016; 31:1222-36. [PMID: 27220499 PMCID: PMC5023605 DOI: 10.1007/s11606-016-3746-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 04/07/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND As survival rates improve, cancer is increasingly considered a chronic illness associated with significant long-term burden and sequelae, both physical and psychological. Various models of cancer care, including primary care physician (PCP)-led and shared-care, have been proposed, though a systematic review of PCPs' perspectives of their role and challenges in providing cancer care remains lacking. This systematic review summarises available literature on PCPs' perspectives of their role in cancer care. METHODS Five databases (MEDLINE, MEDLINE In-Process, EMBASE, PsycINFO and CINAHL) were systematically searched using keywords and MeSH headings for articles from 1993-2015 exploring PCPs' views of their role in the care of patients/survivors of both child and adult cancers. Two independent reviewers screened abstracts for full-text review, abstracted data and performed a quality assessment. RESULTS Thirty-five articles representing the perspectives of 10,941 PCPs were captured. PCPs' confidence to provide care varied according to cancer phase (e.g. treatment versus survivorship), care domain (e.g. acute medical care versus psychological late effects), and disease prevalence (e.g. breast malignancies versus childhood cancers), with preferences for shared- versus independent-care models varying accordingly. Barriers included a lack of timely and specific information/communication from oncologists and limited knowledge/lack of guidelines, as well as lack of time, remuneration and patient trust. LIMITATIONS The data was limited by a lack of consideration of the preferences of patients and oncologists, leading to uncertainty about the acceptability and feasibility of suggested changes to cancer care. DISCUSSION PCPs appear willing to provide cancer care for patients/survivors; however, they report barriers and unmet needs related to providing such care. Future research/interventions should take into account the preferences and needs of PCPs.
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14
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van Weert H. 'The emperor of all maladies': Towards an evidence-based integrated cancer survivorship care in general practice. Eur J Gen Pract 2016; 22:69-70. [PMID: 27292291 DOI: 10.1080/13814788.2016.1180361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Henk van Weert
- a Department of General Practice , AMC , Amsterdam , Netherlands
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15
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Meiklejohn JA, Mimery A, Martin JH, Bailie R, Garvey G, Walpole ET, Adams J, Williamson D, Valery PC. The role of the GP in follow-up cancer care: a systematic literature review. J Cancer Surviv 2016; 10:990-1011. [PMID: 27138994 DOI: 10.1007/s11764-016-0545-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 04/22/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of the present study is to explore the role of the general practitioners, family physicians and primary care physicians (GP) in the provision of follow-up cancer care. METHODS PubMed, MEDLINE and CINAHL were systematically searched for primary research focussing on the role of the GP from the perspective of GPs and patients. Data were extracted using a standardised form and synthesised using a qualitative descriptive approach. RESULTS The initial search generated 6487 articles: 25 quantitative and 33 qualitative articles were included. Articles focused on patients' and GPs' perspectives of the GP role in follow-up cancer care. Some studies reported on the current role of the GP, barriers and enablers to GP involvement from the perspective of the GP and suggestions for future GP roles. Variations in guidelines and practice of follow-up cancer care in the primary health care sector exist. However, GPs and patients across the included studies supported a greater GP role in follow-up cancer care. This included greater support for care coordination, screening, diagnosis and management of physical and psychological effects of cancer and its treatment, symptom and pain relief, health promotion, palliative care and continuing normal general health care provision. CONCLUSION While there are variations in guidelines and practice of follow-up cancer care in the primary health care sector, GPs and patients across the reviewed studies supported a greater role by the GP. IMPLICATIONS FOR CANCER SURVIVORS Greater GP role in cancer care could improve the quality of patient care for cancer survivors. Better communication between the tertiary sector and GP across the cancer phases would enable clear delineation of roles.
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Affiliation(s)
| | - Alexander Mimery
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Jennifer H Martin
- University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Southside Clinical School, University of Queensland, Brisbane, QLD, Australia
| | - Ross Bailie
- National Centre for Quality Improvement in Indigenous Primary Health Care, Menzies School of Health Research, Brisbane, Australia
| | - Gail Garvey
- Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Euan T Walpole
- Princess Alexandra Hospital, Brisbane, QLD, Australia.,Metro South Health Hospital and Health Service, Woolloongabba, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Jon Adams
- Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Daniel Williamson
- Aboriginal and Torres Strait Islander Health Unit, Queensland Health, Brisbane, QLD, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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16
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Duineveld LAM, Wieldraaijer T, Wind J, Verdonck-de Leeuw IM, van Weert HCPM, van Uden-Kraan CF. Primary care-led survivorship care for patients with colon cancer and the use of eHealth: a qualitative study on perspectives of general practitioners. BMJ Open 2016; 6:e010777. [PMID: 27126977 PMCID: PMC4853998 DOI: 10.1136/bmjopen-2015-010777] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore the perspectives of general practitioners (GPs) regarding their current and future role in survivorship care of patients with colon cancer, and to assess their perspectives on patients' self-management capacities and the value of the eHealth application Oncokompas(2.0) used by patients. SETTING GPs from the central part of the Netherlands were interviewed at their location of preference. PARTICIPANTS 20 GPs participated (10 men, 10 women, age range 34-65 years, median age 49.5 years). The median years of experience as a GP was 14.5 years (range 3-34 years). RESULTS GPs indicated attempting to keep in contact with patients after colon cancer treatment and mentioned being aware of symptoms of recurrent disease. Most participants would have liked to be more involved and expected to be able to provide survivorship care of colon cancer. Requirements mentioned were agreements with secondary care and a protocol. GPs considered Oncokompas(2.0), which stimulates patients to structure their own survivorship care, as a useful additional tool for a specific group of patients (ie, young and highly-educated patients). CONCLUSIONS Based on the perspectives of the GPs, survivorship care of colon cancer in primary care is deemed feasible and the use of an eHealth application such as Oncokompas(2.0) is expected to benefit specific groups of patients after colon cancer treatment.
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Affiliation(s)
| | - Thijs Wieldraaijer
- Department of General Practice, Academic Medical Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Wind
- Department of General Practice, Academic Medical Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Henk C P M van Weert
- Department of General Practice, Academic Medical Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
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17
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Vrijmoeth C, Christians MGM, Festen DAM, Groot M, Tonino M, Echteld MA. Physicians' recognition of death in the foreseeable future in patients with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:207-217. [PMID: 26757410 DOI: 10.1111/jir.12240] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 10/01/2015] [Accepted: 10/07/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Physicians are increasingly confronted with people with intellectual disabilities (ID) who are facing life-threatening diseases. We aimed to explore when and based on which information sources and signals physicians recognised that a patient with ID would die in the foreseeable future. Insights may help in identifying patients in need of palliative care. METHOD In this study, 81 physicians for people with ID and 16 general practitioners completed a retrospective survey about their last case of a patient with ID with a non-sudden death. RESULTS More than 20% of all physicians foresaw death not until the last week of life. In 30% of all patients, the physician did not discuss the start of the palliative care phase until the last week. The most reported information sources based on which physicians foresaw death were the physicians themselves and professional caregivers. We found 40 different signals that lead to physicians' foreseeing death. These were not only medical signals but also behavioural and physical signals. CONCLUSIONS Results indicate that the physicians' ability to foresee death is a result of a process of growing awareness in which multiple signals from different information sources converge. This demands continuous multi-disciplinary communication because people involved have their own unique interactions with the patient and can therefore contribute to a growing and timely awareness of patients' death in the future.
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Affiliation(s)
- C Vrijmoeth
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboud University Medical Centre, Nijmegen, Netherlands
- Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Centre, Rotterdam, Netherlands
| | - M G M Christians
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - D A M Festen
- Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Centre, Rotterdam, Netherlands
| | - M Groot
- Department of Anesthesiology, Pain and Palliative Care/Expertise Centre for Palliative Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - M Tonino
- Prisma Foundation, Biezenmortel, Netherlands
| | - M A Echteld
- Prisma Foundation, Biezenmortel, Netherlands
- Science in Balance Foundation, Rotterdam, Netherlands
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18
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van Dipten C, Olde Hartman TC, Biermans MCJ, Assendelft WJJ. Substitution scenario in follow-up of chronic cancer patients in primary care: prevalence, disease duration and estimated extra consultation time. Fam Pract 2016; 33:4-9. [PMID: 26691380 DOI: 10.1093/fampra/cmv098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The incidence of cancer as well as survival rates for it are increasing. It is debated whether care in the chronic phase of cancer can be positioned in primary care due to doubts about capacity and workload. OBJECTIVE To estimate GPs' extra consultation time if they assume responsibility for the care in the chronic phase of cancer. METHOD Retrospective cohort study. Estimation of extra consultation time by quantifying prevalence, incidence, survival, number of chronic cancer patients, current practice contacts and registration of risk factors in patients with all types of cancers. RESULTS The most prevalent types of cancer (with 5-year survival rates) are as follows: breast cancer (91.5%), colorectal cancer (63.8%), prostate cancer (78.3%), melanoma (91.9%) and bladder and urinary tract cancer (77.3%). Primary care practices include ~32 chronic cancer patients, with a potential extra consultation time of ~19 hours per year per 1000 patients. One-third (35%) are already in a chronic disease management programme and 57% were diagnosed >5 years ago. Registration of risk factors for cancer is incomplete, but of better quality when comorbidity is present. CONCLUSION Numbers of chronic cancer patients and possible time investment by primary care professionals in the case of a substitution scenario should not be a limiting factor for transition of follow-up from secondary to primary care, as most of the patients were diagnosed >5 years ago and a large proportion of these patients are already monitored in an existing chronic care programme.
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Affiliation(s)
- C van Dipten
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - T C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M C J Biermans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W J J Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Heins M(M, Korevaar J(J, Donker G(G, Rijken P(M, Schellevis F(F. The combined effect of cancer and chronic diseases on general practitioner consultation rates. Cancer Epidemiol 2015; 39:109-14. [DOI: 10.1016/j.canep.2014.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/02/2014] [Accepted: 12/07/2014] [Indexed: 10/24/2022]
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