Improving communication between the general practitioner and the oncologist: a key role in coordinating care for patients suffering from cancer

Druel, Vladimir; Gimenez, Laëtitia; Paricaud, K.; Delord, Jean‐Pierre; Grosclaude, Pascale; Boussier, Nathalie; Rougé‐Bugat, Marie‐Ève

doi:10.1186/s12885-020-06993-0

Cited by 23 publications

(11 citation statements)

References 42 publications

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“…Uncertainty about what was said exactly by the oncologists appears as an additional stressor as this information is not documented or communicated most of the time. Several studies underline not only the GPs' need to receive adequate and timely information from the hospital team but also the often ineffective communication that leads to disruptive care coordination [19,20,21].…”

Section: Discussionmentioning

confidence: 99%

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

Villalobos

Korezelidou

Unsöld

et al. 2023

Preprint

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Background The timely initiation of end-of-life (EOL) conversations followed by advance care planning (ACP) is considerered best practice for patients with advanced cancer and therefore recommended in oncological guidelines. General practitioners (GPs) play a key role in the coordination of EOL-care and often claim that they have also the reponsibility to initiate the necessary conversations. Nonetheless, the content of these conversations are rarely a subject of communication between GPs and oncology specialists but crucial for timely integration of palliative care. The aim of this study is to explore the GPs‘ perspectives on initiation and conduction of EOL-conversations in patients with metastatic lung cancer and how they perceive the interaction with the oncologists of a cancer center. Methods Qualitative design with in-depth interviews with GPs that refer patients with metastatic lung cancer to a cancer center; thematic analysis following Braun and Clarke. Results We identified three main themes: timing and conduction of EOL-conversations, factors influencing EOL-conversations, and modes of GP-oncologist interaction. All themes showed important and increasing challenges in regard to communication strategies or procedures within the cancer center and between general practitioners and oncologists. Aside from the elucidated challenges of EOL-communication, new problems arise from the difficulties in keeping pace with advances in oncology and the increasing prognostic uncertainty. Additionally, the lack of standardized communication in EOL-topics between GPs and oncologists is underlined. Options in the mode of interaction include written information in reports or digital platforms and direct phone calls. Conclusions Because of the growing complexity in modern oncology, strategies for improvement in GP-oncologist interaction have to consider information about therapeutic advances and prognosis of patients. The increasing prognostic uncertainty hazards the adequate provision and conduction of EOL-conversations and thus, the timely integration of palliative care. As a consequence, a trustful personal interaction that includes direct contact via phone calls between GPs and oncologists should be encouraged.

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Section: Discussionmentioning

confidence: 99%

“…Sometimes we nd it out when talking to the patient." [GP 8,21] GPs express different opinions when deliberating on which mode of interaction with oncologists about EOL-communication could be the most appropriate. Some state that written information is enough, including digital options.…”

Section: "In Most Conversations I Leave It [The Prognosismentioning

confidence: 99%

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

Villalobos

Korezelidou

Unsöld

et al. 2023

Preprint

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“…that the GP should centralise all the cancer-related symptoms (such as adverse effects) together with the non-cancer-related symptoms in a holistic patient-centred approach [ 29 ]. A lack of communication can complicate the overall management, and the patient will more frequently use emergency services [ 30 ]. Making the GP part of the process before the MCM improves coordination and communication [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Adapting patients' oncological treatment through remote participation of general practitioners in multi-disciplinary consultation meetings: A feasibility study

Druel

Gimenez

Tachousin³

et al. 2022

European Journal of General Practice

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Background The general practitioner (GP) is central to managing patients with cancer, whose numbers are increasing worldwide. The GP’s involvement requires better coordination between involved partners, in particular oncologists and GPs. Objectives To conduct a feasibility study of remote participation of GPs in multi-disciplinary consultation meetings (MCMs). We analysed participation, participants’ satisfaction, and their impact on therapeutic decisions. Methods We conducted a feasibility study in the regional cancer centre of Toulouse, France. All patient cases discussed in the MCMs for myelodysplasia from 1 January to 31 March 2016 were included. Cases of patients aged over 18 years, with a diagnosis of myelodysplasia and registered with a GP were included if patients gave informed consent. One investigator collected the data provided by GPs during three telephone or video calls: before, during, and after the MCM, respectively. Results Of 86 patient cases discussed during three months of MCMs, 44 were eligible for GP participation; 27 GPs participated in discussions of 27 patient cases. The GP’s participation in the MCM led to a change in management in five cases, with four times treatment intensifications and once de-intensification. Medical, social, family-related, and psychological domains were discussed with input from the GPs. Overall, all participants were satisfied with the MCMs. Conclusion Remote participation of GPs in MCMs is feasible and may result in adapting oncological and haematological management for patients. This patient-centred approach requires a specific organisation that, when implemented, satisfies the needs of all participants.

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“…Post-operative pain management has shed some light on interdisciplinary coordination practices; both surgeons and PCPs may view prolonged post-operative opioid prescribing as outside of their scope of practice, pointing to utility in early communication between providers and clear role delineation. 43,44 Although the need for coordination between surgeons and PCPs echoes the need for coordination between OBPs and PCPs, 45 acute opioid prescribing cannot always be generalized to chronic cancer or non-cancer pain. 46 In chronic pain settings, clinical coordination through EHR has led to safer and more appropriate opioid prescribing.…”

Section: Discussionmentioning

confidence: 99%

Cross Disciplinary Role Agreement is Needed When Coordinating Long‐Term Opioid Prescribing for Cancer: a Qualitative Study

et al. 2021

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BACKGROUND: Cancer pain is highly prevalent and often managed in primary care or by oncology providers in combination with primary care providers. OBJECTIVES: To understand interdisciplinary provider experiences coordinating opioid pain management for patients with chronic cancer-related pain in a large integrated healthcare system. DESIGN: Qualitative research. PARTICIPANTS: We conducted 20 semi-structured interviews with interdisciplinary providers in two large academically affiliated VA Medical Centers and their associated community-based outpatient clinics. Participants included primary care providers (PCPs) and oncology-based personnel (OBPs). APPROACH: We deductively identified 94 examples of care coordination for cancer pain in the 20 interviews. We secondarily used an inductive open coding approach and identified themes through constant comparison coming to research team consensus. RESULTS: Theme 1: PCPs and OBPs generally believed one provider should handle all opioid prescribing for a specific patient, but did not always agree on who that prescriber should be in the context of cancer pain. Theme 2: There are special circumstances where having multiple prescribers is appropriate (e.g., a pain crisis). Theme 3: A collaborative process to opioid cancer pain management would include real-time communication and negotiation between PCPs and oncology around who will handle opioid prescribing. Theme 4: Providers identified multiple barriers in coordinating cancer pain management across disciplines. CONCLUSIONS:Our findings highlight how real-time negotiation about roles in opioid pain management is needed between interdisciplinary clinicians. Lack of crossdisciplinary role agreement may result in delays in clinically appropriate cancer pain management.

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Improving communication between the general practitioner and the oncologist: a key role in coordinating care for patients suffering from cancer

Cited by 23 publications

References 42 publications

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

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

Adapting patients' oncological treatment through remote participation of general practitioners in multi-disciplinary consultation meetings: A feasibility study

Cross Disciplinary Role Agreement is Needed When Coordinating Long‐Term Opioid Prescribing for Cancer: a Qualitative Study

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