Colorectal cancer patients’ preferences for type of caregiver during survivorship care

Abstract

PurposeColorectal cancer (CRC) survivors are currently included in a secondary care-led survivorship care programme. Efforts are underway to transfer this survivorship care to primary care, but met with some reluctance by patients and caregivers. This study assesses (1) what caregiver patients prefer to contact for symptoms during survivorship care, (2) what patient factors are associated with a preferred caregiver, and (3) whether the type of symptom is associated with a preferred caregiver.MethodsA cross-sectional study of CRC survivors at different time points. For 14 different symptoms, patients reported if they would consult a caregiver, and who they would contact if so. Patient and disease characteristics were retrieved from hospital and general practice records.ResultsTwo hundred and sixty patients participated (response rate 54%) of whom the average age was 67, 54% were male. The median time after surgery was seven months (range 0–60 months). Patients were divided fairly evenly between tumour stages 1–3, 33% had received chemotherapy. Men, patients older than 65 years, and patients with chronic comorbid conditions preferred to consult their general practitioner (GP). Women, patients with stage 3 disease, and patients that had received chemotherapy preferred to consult their secondary care provider. For all symptoms, patients were more likely to consult their GP, except for (1) rectal blood loss, (2) weight loss, and (3) fear that cancer had recurred, in which case they would consult both their primary and secondary care providers. Patients appreciated all caregivers involved in survivorship care highly; with 8 out of 10 points.ConclusionsCRC survivors frequently consult their GP in the current situation, and for symptoms that could alarm them to a possible recurrent disease consult both their GP and secondary care provider. Patient and tumour characteristics influence patients’ preferred caregiver.

Introducing a time out consultation with the general practitioner between diagnosis and start of colorectal cancer treatment: Patient‐reported outcomes

“…In line with previous findings (Wieldraaijer et al, , ), patients in general reported to be content with their GP. Even before the introduction of the “time out consultation”, two‐thirds of all CRC patients were in contact with their GP between diagnosis and start of treatment.…”

“…Men were significantly more satisfied with their GP's care after the introduction of the consultation. This observation was made in an earlier study (Wieldraaijer et al, 2018), and part of the explanation may be offered by Christen et al (2016), who report that women prefer cancer survivorship care to be organised in a hospital setting over a primary care setting, and speculate this may be because women expect more supportive care in a secondary care setting.…”

“…A systematic review by Henselmans et al (2013) showed the beneficial effect of initial treatment-planning consultations on observed patient participation in general. Older patients, especially those with comorbid conditions, are generally better acquainted with their GPs, which is likely to benefit constructive GP consultation and agreement on supportive care during and after treatment (Berendsen et al, 2010;Heins et al, 2016;Wieldraaijer et al, 2018). Consequently, GPs should realise that older patients in particular could benefit from a "time out consultation" of sorts before start of treatment, because of their often more complex medical histories and fragile living situations.…”

Health care provider and patient preparedness for alternative colorectal cancer follow-up; a review

“…Lastly, patients reported that GP-led follow-up improved the continuity of care. Older men and patients with chronic comorbid diseases had a special preference for GP-led follow-up [44,45,53,56,58,60,69]. Nonetheless, follow-up by GPs comes with disadvantages.…”

Health-related preferences of older patients with multimorbidity: an evidence map

“…Twelve studies (8%) focused on preferences for certain healthcare services, and specifically (1) preferred care processes (10/12),45 135–143 such as continuity of care, accessibility and acceptance of the substitution of a physician by nurses and (2) service models (2/12),31 144 perhaps asking patients about their preferences regarding Chronic Care Model recommendations 31…”