The on-going care of patients with cancer: what is the appropriate balance of cancer care between specialists and primary care?

R Medicine (General);RA Public aspects of medicine

Smith, Fiona Jane Elizabeth ; O'Donnell, Catherine

University:University of Glasgow

Department:School of Medicine, Dentistry & Nursing

关键词: Survivorship, cancer care, health professionals;   

Others  :  http://theses.gla.ac.uk/5970/1/2015SmithFJEPhD.pdf

来源: University of Glasgow

【 摘 要 】

Background:Mortality rates have fallen resulting in people living longer with cancer. However, cancer survivors can face significant treatment related physical and psychosocial issues including comorbidities.Treatment related side effects can persist in the long-term or may occur many years later. There is now a focus on the best way to provide appropriate care to people who have survived cancer and its treatment.Aim:The aim of this study is to explore the appropriate balance of cancer care for patients following diagnosis and treatment between specialist and primary care.Methods:Semi-structured interviews with a purposive sample of 40 oncologists, CNSs and GPs across Scotland. Data are analysed in a systematic fashion using constant comparison.Findings:Many patients face significant health care issues after a diagnosis of cancer. Professionals often play a pivotal role during follow-up by identifying and managing patients’ physical and psychosocial needs and by sign posting to address the challenges that arise. Psychosocial needs, long-term and late effects are sometimes not addressed. Oncologists are leaders of the cancer care process. CNSs often play a central role in survivorship both in specialist and primary care. GPs’ roles are seen to span the full spectrum of survivorship care, although this is largely opportunistic in nature. Communication between specialist and primary care is a key issue. Professionals perceived that there is insufficient contact across the interface in terms of understanding others’ viewpoints about the nature of their work.Efforts are needed to improve the timeliness and detail of letters to primary care. Successful primary care follow-up may require development of nurses’ roles in general practice and the community. It is perceived that GPs could attend specialist care for survivorship education or become cancer specialists in general practice. Cancer Care Reviews are considered useful tools in terms of allowing GPs to engage with their patients. Improvements to technology and further research are considered central to optimal cancer care. Conclusion: Considerable barriers exist with the current system of follow-up.After the treatment phase, GP survivorship care is largely opportunistic and driven by patients’ needs. Based on the findings from this study, strategies of care could potentially be planned to facilitate the role of primary care. However, research supporting these practices is needed.