The Two Solitudes of Primary Care and Cancer Specialist Care: Is There a Bridge?

Grunfeld, Eva

doi:10.3747/co.24.3488

Cited by 6 publications

(10 citation statements)

References 11 publications

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“…A number of qualitative 7 and intervention or disease cohort studies, including randomized trials 8 , have been carried out, but we found no population-based studies that identify the individuals who are and are not using navigation. Furthermore, the need for navigation might be changing, given the accelerating discovery of innovative cancer treatments, the fact that more people are living longer with cancer 9 , the current focus on narrowing the gap between oncology and primary care 10,11 , the aging of the population, and greater interest in advance care planning and a palliative approach to care [12][13][14] . Population-based surveillance of people with life-limiting conditions can provide evidence that will help in critically appraising established navigation programs.…”

Section: Introductionmentioning

confidence: 99%

Comparing Enrolees with Non-Enrolees of Cancer-Patient Navigation at End of Life

Park¹,

Johnston

Urquhart³

et al. 2018

Current Oncology

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Section: Introductionmentioning

confidence: 99%

Comparing Enrolees with Non-Enrolees of Cancer-Patient Navigation at End of Life

Park¹,

Johnston

Urquhart³

et al. 2018

Current Oncology

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“…These results are relevant in the context of bridging the "two soli tudes" of primary and specialist care. 4 Participant suggestions, namely the implementation of care pathways with further support for family physicians, are important, given the strong promotion of pathways in the Canadian context to guide care of patients with different can cer types. 17 A successful example is the Alberta Breast Cancer Diagnostic Assessment Pathway, which addresses variation and wait time between discovery of a highly suspicious finding on imaging and referral to a breast program.…”

Section: Suggestionsmentioning

confidence: 99%

“…1,2 In Canada, family physicians make important contributions to the care of people with can cer throughout the care continuum. 3,4 Academic discussions related to this topic have focused on providing clarity about the role of family physicians, and on identifying challenges pertaining to the provision of cancer care in the commun ity. 3,[5][6][7] However, the emphasis has been mainly on post diagnostic care, with a particular focus on transitions from specialty cancer care back to the community.…”

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confidence: 99%

Physician perspectives on delays in cancer diagnosis in Alberta: a qualitative study

Botey

GermAnn

Robson

et al. 2021

cmajo

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Background: Delays in cancer diagnosis have been associated with reduced survival, decreased quality of life after treatment, and suboptimal patient experience. The objective of the study was to explore the perspectives of a group of family physicians and other specialists regarding potentially avoidable delays in diagnosing cancer, and approaches that may help expedite the process. Methods:We conducted a qualitative study using interviews with physicians practising in primary and outpatient care settings in Alberta between July and September 2019. We recruited family physicians and specialists who were in a position to discuss delays in cancer diagnosis by email via the Cancer Strategic Clinical Network and the Alberta Medical Association. We conducted semistructured interviews over the phone, and analyzed data using thematic analysis.Results: Eleven family physicians and 22 other specialists (including 7 surgeons or surgical oncologists, 3 pathologists, 3 radiologists, 2 emergency physicians and 2 hematologists) participated in interviews; 22 were male (66.7%). We identified 4 main themes describing 9 factors contributing to potentially avoidable delays in diagnosis, namely the nature of primary care, initial presentation, investigation, and specialist advice and referral. We also identified 1 theme describing 3 suggestions for improvement, including system integration, standardized care pathways and a centralized advice, triage and referral support service for family physicians.Interpretation: These findings suggest the need for enhanced support for family physicians, and better integration of primary and specialty care before cancer diagnosis. A multifaceted and coordinated approach to streamlining cancer diagnosis is required, with the goals of enhancing patient outcomes, reducing physician frustration and optimizing efficiency.

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“… 1 In periods with intensive treatment in hospital, it is often unclear to patients who will take care of their comorbidities and psychosocial aspects of living with a life-threatening disorder. 2 The integration of general practitioners (GPs) into survivorship care is needed and underpinned internationally. 3 However, GPs may feel insufficiently informed by specialists and thereby be left with an unclearly defined role.…”

Section: Introductionmentioning

confidence: 99%

Cross-sectoral communication by bringing together patient with cancer, general practitioner and oncologist in a video-based consultation: a qualitative study of oncologists’ and nurse specialists’ perspectives

et al. 2021

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Shared care models in the field of cancer aim to improve care coordination, role clarification and patient satisfaction. Cross-sectoral communication is pivotal. Involvement of patients may add to intended mechanisms.A randomised controlled trial ‘The Partnership Study’ tested the effect of bringing together patient, general practitioner (GP) and oncologist for a consultation conducted by video.PurposeAs part of the process evaluation, this study aimed to explore experiences, attitudes and perspectives of the oncological department on sharing patient consultations with GPs using video.MethodsFour semistructured interviews with five oncologists and four nurse specialists were conducted in February 2020. We focused on the informants’ experiences and reflections on the potential of future implementation of the concept ‘inviting the GP for a shared consultation by video’. The analyses were based on an inductive, open-minded, hermeneutic phenomenological approach.ResultsA total of six overall themes were identified: structuring consultation and communication, perceptions of GP involvement in cancer care, stressors, making a difference, alternative ways of cross-sector communication and needs for redesigning the model. The concept made sense and was deemed useful, but solving the many technical and organisational problems is pivotal. Case-specific tasks and relational issues were targeted by pragmatically rethinking protocol expectations and the usual way of communication and structuring patient encounters. Case selection was discussed as one way of maturing the concept.ConclusionThis Danish study adds new insight into understanding different aspects of the process, causal mechanisms as well as the potential of future implementation of video-based tripartite encounters. Beyond solving the technical problems, case selection and organisational issues are important. Acknowledging the disruption of the usual workflow, the introduction of new phases of the usual encounter and the variety of patient–GP relationships to be embraced may help to better understand and comply with barriers and facilitators of communication and sharing.Trial registration numberNCT02716168.

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The Two Solitudes of Primary Care and Cancer Specialist Care: Is There a Bridge?

Abstract: -

Cited by 6 publications

References 11 publications

Comparing Enrolees with Non-Enrolees of Cancer-Patient Navigation at End of Life

Comparing Enrolees with Non-Enrolees of Cancer-Patient Navigation at End of Life

Physician perspectives on delays in cancer diagnosis in Alberta: a qualitative study

Cross-sectoral communication by bringing together patient with cancer, general practitioner and oncologist in a video-based consultation: a qualitative study of oncologists’ and nurse specialists’ perspectives

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