Experimental system of care coordination for the home return of patients with metastatic cancer: a survey of general practitioners

Abstract

Background To promote improved coordination between general practice and hospital, the French clinical trial CREDO (“Concertation de REtour à DOmicile”) is testing an innovative experimental consultation for patients with metastatic cancer who are returning home. This consultation involves the patient, the patient’s referring GP (GPref) and a GP with specific skills in oncology (GPonc) in a specialized care center. The objective of our study is to explore the satisfaction of GPsref about this consultation, in the phase of interaction between GPonc and GPref. Methods This observational, cross-sectional, multicenter study explored the satisfaction of GPsref who had participated in this type of consultation, via a telephone survey. Results One Hundred GPsref responded to the questionnaire between April and September 2019 (overall response rate: 55%). 84.5% were satisfied with the consultation, and the majority were satisfied with its methods. Half of the GPsref learned new information during the consultation, three-quarters noted an impact on their practice, and 94.4% thought that this type of coordination between the GPref and the oncology specialist could improve general practice - hospital coordination. Conclusions For GPs, the CREDO consultation seems to be practical and effective in improving the coordination between general medicine and hospital. GPs would benefit from such coordination for all patients with cancer, several times during follow-up and at each occurrence of a medically significant event.

Challenges of general practitioner-oncologist interaction in end-of-life communication: a qualitative study

“…It's so complex, the third antibody or the third checkpoint-inhibitor for lung cancer, I don't know it." [ GP 10,33] Because of the knowledge gap it is di cult for GPs to determine the risk-bene t ratio or to decide on the end of a cancer treatment. The rapid changes in oncological treatment options may even lead to avoidance of talking about prognosis and EOL at all.…”

“…Normally I follow the hospital's recommendations." [ GP 3,33] On the other hand, some situations seem problematic when opinions about treatment goals differ. Some GPs choose patient-empowerment as a strategy.…”

“…To improve interdisciplinary collaboration, studies implementing new strategies have shown some success: e.g. remote participation of GPs in multidisciplinary meetings at the cancer center or integrating GPs with speci c oncological skills in the center before the home return of patients [32,33]. Still, review of the literature shows that the direct oral communication during the active phase of cancer treatment should be further developed [34].…”

Increasing challenges of general practitioner-oncologist interaction in end-of-life communication: a qualitative study

“…To improve interdisciplinary collaboration, studies implementing new strategies have shown some success: e.g. remote participation of GPs in multi-disciplinary meetings at the cancer center or integrating GPs with speci c oncological skills in the center before the home return of patients [33,34]. Still, review of the literature shows that the direct oral communication during the active phase of cancer treatment should be further developed [35].…”