GP-led melanoma follow-up: the practical experience of GPs

Murchie, Peter; Delaney, Elizabeth K; Campbell, Neil; Hannaford, Philip Christopher

doi:10.1093/fampra/cmp035

Cited by 15 publications

(19 citation statements)

References 17 publications

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“…Concern about lack of time, resources, workload and few advantages for their practice [8,30] ✓ ✓ Concern about reduced reassurance for patients [30] ✓ Concern about GPs limited experience [8,30] ✓ ✓ Benefits Potential to improve convenience and continuity for patients [30] ✓ ✓ Potential for greater involvement by GPs in melanoma care [30] ✓ Potential for increased knowledge and skills of GPs [30] ✓ Potential to free up specialists time [30] ✓ Experiences (one study) Positive Comfortable conducting GP-led melanoma follow-up, few reported problems [29] ✓ Importance of training, protocols, recall system and rapid referral pathway to specialists [29] ✓ ✓ Perceived advantage of specialist training/interest in dermatology, but not required [29] ✓ Ideally placed to deliver follow-up care [29] ✓ Minimal disruption of GP practice [29] ✓ GP-led care applicable in all locations, although rural GPs more enthusiastic [29] ✓ Patients' experiences perceived as positive [29] ✓ More efficient use of skin specialist [29] ✓ Negative/concerns…”

Section: Requirementsmentioning

confidence: 99%

“…Maintaining adequate level of expertise if patient numbers small [29] ✓ ✓ Consumption of limited resources [29] ✓ Workload and increased potential for transfer of other tasks to GPs in future [29] ✓ GP on leave when patient recall letter sent out [29] ✓ Patients introducing other matters to follow-up consultation [29] ✓ Patients pre-empting melanoma follow-up as part of consultation on other matters [29] ✓ Adherence (one study)…”

Section: Requirementsmentioning

confidence: 99%

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Psychosocial aspects of post‐treatment follow‐up for stage I/II melanoma: a systematic review of the literature

et al. 2012

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ObjectiveTo systematically review the literature on the psychosocial aspects of post-treatment followup of stage I/II primary cutaneous melanoma. While less frequent monitoring schedules may be equally effective in detecting recurrent and new melanoma, psychosocial aspects of follow-up should also be considered when protocols are revised. Data SourcesAll years in Medline, PsycINFO, CINAHL, Embase, Cochrane Library, ACP Journal Club and NHS Economic Evaluation Database until April 2010. Study SelectionAll empirical studies with an English abstract that included psychosocial measures of anticipated or experienced outcomes of routine follow-up as reported by patients or clinicians. Data ExtractionThe search identified 1,143 articles, of which 918 were reviewed by title and abstract, and 74 underwent full-text review. A total of 15 studies met the inclusion criteria. Data SynthesisPatients experienced anxiety associated with follow-up but valued reassurance, information and psychosocial support. Some wanted more emotional support from their clinician than is provided. Some clinicians ordered additional non-recommended blood and imaging tests to reassure patients. Patient satisfaction with follow-up was high but adherence to schedules 3 was variable. Difficulties attending hospital clinics were an important barrier, and some patients attended multiple providers. GPs were hesitant to conduct follow-up but a trial providing training and structured protocols reported positive outcomes. GPs and patients emphasized the importance of skills to conduct skin checks and self-examination and wanted prompt access to specialists when required. ConclusionsThe psychosocial factors identified in this review should be taken into account when followup protocols for stage I/II melanoma are revised.4

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Section: Requirementsmentioning

confidence: 99%

Section: Requirementsmentioning

confidence: 99%

Psychosocial aspects of post‐treatment follow‐up for stage I/II melanoma: a systematic review of the literature

et al. 2012

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“…The proportion of melanoma follow-up conducted as shared care is currently unknown. And while GP and patient experiences of shared care in melanoma follow-up have been described [26,27], no studies have examined shared care from the perspective of melanoma clinicians.…”

Section: Introductionmentioning

confidence: 99%

Shared care in the follow-up of early-stage melanoma: a qualitative study of Australian melanoma clinicians’ perspectives and models of care

Rychetnik

Morton

McCaffery

et al. 2012

BMC Health Serv Res

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BackgroundPatients with early stage melanoma have high survival rates but require long-term follow-up to detect recurrences and/or new primary tumours. Shared care between melanoma specialists and general practitioners is an increasingly important approach to meeting the needs of a growing population of melanoma survivors.MethodsIn-depth qualitative study based on semi-structured interviews with 16 clinicians (surgical oncologists, dermatologists and melanoma unit GPs) who conduct post-treatment follow-up at two of Australia’s largest specialist referral melanoma treatment and diagnosis units. Interviews were recorded, transcribed and analysed to identify approaches to shared care in follow-up, variations in practice, and explanations of these.ResultsMelanoma unit clinicians utilised shared care in the follow-up of patients with early stage melanoma. Schedules were determined by patients’ clinical risk profiles. Final arrangements for delivery of those schedules (by whom and where) were influenced by additional psychosocial, professional and organizational considerations. Four models of shared care were described: (a) surgical oncologist alternating with dermatologist (in-house or local to patient); (b) melanoma unit dermatologist and other local doctor (e.g. family physician); (c) surgical oncologist and local doctor; or (d) melanoma physician and local doctor.ConclusionsThese models of shared care offer alternative solutions to managing the requirements for long-term follow-up of a growing number of patients with stage I/II melanoma, and warrant further comparative evaluation of outcomes in clinical trials, with detailed cost/benefit analyses.

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“…This analysis was based on the small subset of articles (n=14) that included a comparison of surveillance practices by physician specialty. Recommendations for both surveillance intervals and diagnostic imaging and laboratory evaluations varied by specialty [26, 33, 36, 45, 50–55]. The greatest variation was seen with respect to recommended frequency of follow-up visits for patients with stage I disease, which ranged from 2 to 4 times per year.…”

Section: Resultsmentioning

confidence: 99%

“…Self-examination was a universal recommendation from every country [21, 34, 41, 42, 48, 49, 59–66] and by all practitioner specialties [33, 51, 52, 54, 55, 62, 67–70] Surveillance recommendations varied the greatest for patients with stage I disease. Recommended imaging and laboratory evaluations were most intense in the United Kingdom and most minimalist in The Netherlands.…”

Section: Discussionmentioning

confidence: 99%

Variability in melanoma post-treatment surveillance practices by country and physician specialty

et al. 2012

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Background There are no evidence-based guidelines for surveillance of patients with melanoma following surgical treatment. We performed a systematic review to identify current stage-specific surveillance practices for patients with melanoma by country and physician specialty. Methods Three major medical indices, MEDLINE, the Cochrane Library database, and Scopus, were reviewed to identify articles published in January 1970 to October 2011 that included detailed information about surveillance of patients with melanoma after initial surgical treatment. Data on surveillance intervals and recommended evaluation were extracted and categorized by country and, when reported, physician specialty. Results One hundred four articles from 10 countries and 4 physician specialties (dermatology, surgical oncology, medical oncology, and general practice) met the inclusion criteria, including 43 providing specific patient-level data. The articles showed wide variation with respect to surveillance intervals and recommended evaluations. Variation was greatest for patients with stage I disease, for whom follow-up frequency ranged from 1 to 6 visits per year during years 1 and 2 after treatment. All 4 physician specialties agreed that for years 1–3, the follow-up frequency should be 4 times per year for all patients. For years 4 and 5, surgical oncologists recommended 2 follow-up visits per year, whereas general practitioners, dermatologists, and medical oncologists recommended 4 visits per year. Recommended imaging and laboratory evaluations were most intense in the United Kingdom and most minimalist in The Netherlands. While general practitioners did not recommend routine laboratory or imaging tests for surveillance, all other specialties utilized both in their surveillance practice. Self skin-examination was recommended for surveillance in all countries and by all practitioner specialties. Conclusions There is significant intercountry and interspecialty variation in surveillance of patients with melanoma. As the number of melanoma survivors increases, it will be critical to examine the benefits and costs of various follow-up strategies to establish consensus guidelines for melanoma post-treatment surveillance.

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GP-led melanoma follow-up: the practical experience of GPs

Abstract: GP-led melanoma follow-up is feasible and, provided certain concerns can be addressed, GPs are willing to provide it.

Cited by 15 publications

References 17 publications

Psychosocial aspects of post‐treatment follow‐up for stage I/II melanoma: a systematic review of the literature

Psychosocial aspects of post‐treatment follow‐up for stage I/II melanoma: a systematic review of the literature

Shared care in the follow-up of early-stage melanoma: a qualitative study of Australian melanoma clinicians’ perspectives and models of care

Variability in melanoma post-treatment surveillance practices by country and physician specialty

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