Patients with cancer and change of general practice: a Danish population-based cohort study

Grooss, Kasper; Hjertholm, Peter; Carlsen, Anders Helles; Vedsted, Peter

doi:10.3399/bjgp16x685633

Cited by 6 publications

(12 citation statements)

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“…A study has shown that patients with cancers that are “hard‐to‐detect” more frequently changed GP around the time of diagnosis compared to other cancer patients (Grooss, Hjertholm, Carlsen, & Vedsted, ). This may indicate dissatisfaction with timeliness and the diagnostic pathways, which is supported by the results of this survey.…”

Section: Discussionmentioning

confidence: 99%

Cancer patients’ experiences with urgent referrals to cancer patient pathways

et al. 2018

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Objective We aimed to explore whether cancer patients urgently referred to a cancer patient pathway (CPP) (CPP referred) by a general practitioner report experiences of pre‐diagnosis cancer care differently than patients not referred to a CPP (non‐CPP referred). Methods Data were collected from cross‐sectional questionnaire surveys among cancer patients and their GPs and linked to National registries. Poisson regression was used to generate adjusted prevalence ratios (PR) to compare reported experiences. Results The study included 2,256 individuals. CPP referred patients reported more positive overall experiences of the pre‐diagnosis phase (p < 0.001). Overall, CPP referred patients were 21% more likely than non‐CPP referred patients to report a positive experience after adjustment for case‐mix, comorbidity, disposable household income and educational level (PR = 1.21 [95% CI: 1.11–1.30]). The difference decreased to 14% when adjusted for Quality Deviations (PR = 1.14 [95% CI: 1.06–1.23]) and to 11% when adjusted for diagnostic interval (PR = 1.11 [95% CI: 1.02–1.20]). Conclusion Our findings suggest that CPP referred cancer patients have better experiences of pre‐diagnosis cancer care compared to non‐CPP referred patients. A substantial part of the difference could be attributed to shorter diagnostic intervals and/or the absence of quality deviations among CPP patients, which reveals the potential for generally improving cancer patients’ experiences by seamless and optimised diagnostic pathways.

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Section: Discussionmentioning

confidence: 99%

Cancer patients’ experiences with urgent referrals to cancer patient pathways

et al. 2018

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“…Although dissatisfaction with the diagnostic pathway of PD appears to be playing a limited role in quantitative terms, dissatisfaction with the initial diagnostic process can have an impact on long-term care, stressing the importance of paying attention to it: cognitions formed at an early stage tend to determine care experiences during the further treatment episode [ 2 , 5 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…We wanted to assess the relation between dissatisfaction with the diagnostic pathway and a selection of factors. These factors were selected based on literature [ 5 , 18 ], the results of the preceding qualitative analysis [ 16 ] and expert opinion. The χ 2 test was used to assess the relation between dissatisfaction and the demographic variables sex and level of education, the latter divided into low (primary school/vocational education), medium (secondary school) and high (higher professional education/university).…”

Section: Methodsmentioning

confidence: 99%

“…Diagnosis timing issues may induce patients to change general practice [ 5 ]. The importance of timeliness of diagnosis related to patient dissatisfaction emerges from a study amongst cancer patients, showing that patients suffering from cancer types that are difficult to recognise, such as ovarian cancer and multiple myeloma, are more likely to change practice than patients with types of cancer that are easier to recognise, such as melanoma and breast cancer [ 5 ]. In addition, long-term care experiences of cancer patients are worse for those who visited their GP several times before they were referred than for those who were referred instantly [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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The diagnostic pathway of Parkinson’s disease: a cross-sectional survey study of factors influencing patient dissatisfaction

et al. 2017

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BackgroundThe diagnostic pathway of Parkinson’s disease (PD) is often complicated. Experiences during this pathway can affect patients’ satisfaction and their confidence and trust in healthcare providers. Although healthcare providers cannot influence the impact of the diagnosis, they can influence how patients experience the pathway. This study, therefore, aims to provide insight into PD patients’ dissatisfaction with the diagnostic pathway and to describe the factors that influence it.MethodsWe carried out a cross-sectional survey study among 902 patient members of the Dutch Parkinson’s Disease Association, who were each asked to write an essay about their diagnostic pathway. A coding format was developed to examine the content of these essays. Inter-observer agreement on coding patient dissatisfaction was calculated using Cohen’s kappa. The χ2 test and a multivariable logistic regression analysis were performed to assess the relation between dissatisfaction and sex, level of education, duration of the pathway, communication with the general practitioner (GP) and the neurologist, the number of healthcare providers involved, whether or not a second opinion had taken place (including the person who initiated it) and diagnostic delay (taking into consideration who caused the delay according to the patient). A subgroup analysis was performed to gain insight into sex-related differences.ResultsOf all patients, 16.4% explicitly described they were dissatisfied with the diagnostic pathway, whereas 4.8% were very satisfied. The inter-observer agreement on coding dissatisfaction was κ = 0.82. The chance of dissatisfaction increased with a lower level of education, the involvement of more than one additional healthcare provider, a second opinion initiated by the patient and delay caused by a healthcare provider. When only the GP and the neurologist were involved, women were more likely to be dissatisfied than men.ConclusionsPD patients’ dissatisfaction with the diagnostic pathway is related to a lower level of education, a second opinion initiated by the patient and experienced diagnostic delay. GPs can positively influence patients’ experiences if they are aware of these risk factors for dissatisfaction and pay extra attention to communication and shared decision making. This will contribute to a trusting therapeutic relationship that is indispensable with progression of the disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0652-y) contains supplementary material, which is available to authorized users.

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“…(2008), ASCO-ESMO (2006), ACoSCo (2016), Edwards (2016), National Quality Forum (NQF) (2009), Grunfeld et al (2008), Jensen, Torring et al (2014), Jensen et al (2016), Levit et al (2013), Parker et al (2007), Raval et al (2010), Vargas, Ryan, Jackson, Rodriguez, and Freeman al. (2008), Almeida et al (2013), Arrighi et al (2015), ASCO (2006), Barocas and Penson (2010), Burmeister et al (2016), ACoSCo (2016), Earle (2007), Feld and Feld (2010), Forum (2009), Grunfeld et al (2008), Holland and Weiss (2008), Holland, Watson, and Dunn (2011), Langer and Stern (2007), Lebeau et al (2011), Levit et al (2013), Manchon-Walsh et al (2011), Mano et al (2008), Mathis and Cima (2014), Meert and Sculier (2008), Numico et al (2014), Ost, Niu, Elting, Buchholz, and Giordano (2014), Pagano et al (2010), Raval et al (2010), Rizzo et al (2011), Saini et al (2016), Samson, Porter, Hurley, Adams, and Eberth (2016), Schrader et al (2010), Spencer et al (2008), Stordeur et al (2015), Taflampas et al (2008), van de Velde et al (2013), Wang et al ), AielloBowles et al (2008),Anderson (2016),Arrighi et al (2015),ASCO (2006),Burmeister et al (2016),Earle (2007),Grooss, Hjertholm, Carlsen, and Vedsted (2016),Grunfeld et al (2008),Holland and Weiss (2008),Lamb, Brown, et al (2011), Lamb, Sevdalis, Mostafid, Vincent, and Green (2011), Lamb, Sevdalis, Vincent, and Green (2012,Lebeau et al (2011),Levit et al (2013),Nazareth et al (2008), NQF (2009),Riquet et al (2013),Rizzo et al (2011), Stordeur et al (2015,Tremblay et al (2011), Vargas et al (2008,Wang et al (2012)…”

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confidence: 99%

A narrative synthesis of the quality of cancer care and development of an integrated conceptual framework

et al. 2018

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The general paradigms that exist to guide measures in quality of care do not sufficiently deal with the changing needs of cancer management. The aim of this study was to review the literature regarding the quality of cancer care and develop a conceptual framework relevant to current practice. A textual narrative review of the literature was conducted by searching electronic databases from the last 10 years. Articles were then screened and included if they were both relevant to the management of cancer and standards in quality of care. Thematic analysis of the included articles was performed. Eighty-three articles were included and 12 domains identified and integrated with current models to develop a conceptual framework. These included: healthcare delivery system; timeliness; access; appropriateness of care; multidisciplinary and coordinated care; patient experience; technical aspects; safety; patient-centred outcomes; disease-specific outcomes; innovation and improvement and value. We propose a conceptual framework for the quality of cancer care based on relevant and current oncology practice. This presents a more practical and comprehensive approach than general models, and can be used by healthcare providers, managers and policy makers to guide and identify the need for metrics for quality improvements.

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Patients with cancer and change of general practice: a Danish population-based cohort study

Abstract: BackgroundGeneral practice plays an important role in the cancer care pathway. Patient dissatisfaction with the diagnostic process may be expressed by changing to another general practice.

Cited by 6 publications

References 26 publications

Cancer patients’ experiences with urgent referrals to cancer patient pathways

Cancer patients’ experiences with urgent referrals to cancer patient pathways

The diagnostic pathway of Parkinson’s disease: a cross-sectional survey study of factors influencing patient dissatisfaction

A narrative synthesis of the quality of cancer care and development of an integrated conceptual framework

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