Delivering colon cancer survivorship care in primary care; a qualitative study on the experiences of general practitioners

Abstract

Background With more patients in need of oncological care, there is a growing interest to transfer survivorship care from specialist to general practitioner (GP). The ongoing I CARE study was initiated in 2015 in the Netherlands to compare (usual) surgeon- to GP-led survivorship care, with or without access to a supporting eHealth application (Oncokompas). Methods Semi-structured interviews were held at two separate points in time (i.e. after 1- and 5-years of care) to explore GPs’ experiences with delivering this survivorship care intervention, and study its implementation into daily practice. Purposive sampling was used to recruit 17 GPs. Normalisation Process Theory (NPT) was used as a conceptual framework. Results Overall, delivering survivorship care was not deemed difficult and dealing with cancer repercussions was already considered part of a GPs’ work. Though GPs readily identified advantages for patients, caregivers and society, differences were seen in GPs’ commitment to the intervention and whether it felt right for them to be involved. Patients’ initiative with respect to planning, absence of symptoms and regular check-ups due to other chronic care were considered to facilitate the delivery of care. Prominent barriers included GPs’ lack of experience and routine, but also lack of clarity regarding roles and responsibilities for organising care. Need for a monitoring system was often mentioned to reduce the risk of non-compliance. GPs were reticent about a possible future transfer of survivorship care towards primary care due to increases in workload and financial constraints. GPs were not aware of their patients’ use of eHealth. Conclusions GPs’ opinions and beliefs about a possible future role in colon cancer survivorship care vary. Though GPs recognize potential benefit, there is no consensus about transferring survivorship care to primary care on a permanent basis. Barriers and facilitators to implementation highlight the importance of both personal and system level factors. Conditions are put forth relating to time, reorganisation of infrastructure, extra personnel and financial compensation. Trial registration Netherlands Trial Register; NTR4860. Registered on the 2nd of October 2014.

SCORE: a randomised controlled trial evaluating shared care (general practitioner and oncologist) follow-up compared to usual oncologist follow-up for survivors of colorectal cancer

“…Possible reasons for this, supported by several studies, include reluctance of GPs to assume full responsibility for survivorship care, reluctance of oncology specialists to transfer care, and patient preference to maintain contact with oncology providers. 29 , 30 , 31 Shared care offers potential advantages including that there is no full transfer of care, or this transfer is gradual.…”

“…Despite these studies, GP-led follow-up care has not been widely adopted. 29 , 30 , 31 Our own work with survivors, GPs, surgeons and oncologists reported strong support for GPs to be involved in the ongoing care of CRC survivors and that GPs should be provided with information to facilitate care. 32 …”

Detection of colon cancer recurrences during follow-up care by general practitioners vs surgeons

“…GPs have an important role in cancer management, and providing them with education and training is helpful and can increase confidence and knowledge and change behavior ( 29 ). For the GP to take over completely, it will require additional time, compensation, and reorganization of the infrastructure ( 30 ). It will also require a clear understanding of the roles and responsibilities in which the patient and GP need to come to an agreement on who will take the lead in organizing follow-up ( 31 ).…”

Cost-effectiveness of general practitioner- versus surgeon-led colon cancer survivorship care: an economic evaluation alongside a randomised controlled trial

“…However, when it comes to evaluating and implementing new models of care, it is also important to consider other factors, including patient and physician preferences [15]. I CARE participants also mentioned barriers to engaging GPs in cancer care [43,44]. Barriers included, among others, a lack of knowledge and experience of GPs and the amount of extra work for GPs.…”