Delivering colon cancer survivorship care in primary care; a qualitative study on the experiences of general practitioners

Julien A M Vos,Laura A M Duineveld,Henk C P M Van Weert,Kristel M Van Asselt,Robin De Best

doi:10.1186/s12875-021-01610-w

Julien A M Vos, Laura A M Duineveld + Show 3 more

Open Access

https://doi.org/10.1186/s12875-021-01610-w

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Abstract

BackgroundWith more patients in need of oncological care, there is a growing interest to transfer survivorship care from specialist to general practitioner (GP). The ongoing I CARE study was initiated in 2015 in the Netherlands to compare (usual) surgeon- to GP-led survivorship care, with or without access to a supporting eHealth application (Oncokompas).MethodsSemi-structured interviews were held at two separate points in time (i.e. after 1- and 5-years of care) to explore GPs’ experiences with delivering this survivorship care intervention, and study its implementation into daily practice. Purposive sampling was used to recruit 17 GPs. Normalisation Process Theory (NPT) was used as a conceptual framework.ResultsOverall, delivering survivorship care was not deemed difficult and dealing with cancer repercussions was already considered part of a GPs’ work. Though GPs readily identified advantages for patients, caregivers and society, differences were seen in GPs’ commitment to the intervention and whether it felt right for them to be involved. Patients’ initiative with respect to planning, absence of symptoms and regular check-ups due to other chronic care were considered to facilitate the delivery of care. Prominent barriers included GPs’ lack of experience and routine, but also lack of clarity regarding roles and responsibilities for organising care. Need for a monitoring system was often mentioned to reduce the risk of non-compliance. GPs were reticent about a possible future transfer of survivorship care towards primary care due to increases in workload and financial constraints. GPs were not aware of their patients’ use of eHealth.ConclusionsGPs’ opinions and beliefs about a possible future role in colon cancer survivorship care vary. Though GPs recognize potential benefit, there is no consensus about transferring survivorship care to primary care on a permanent basis. Barriers and facilitators to implementation highlight the importance of both personal and system level factors. Conditions are put forth relating to time, reorganisation of infrastructure, extra personnel and financial compensation.Trial registrationNetherlands Trial Register; NTR4860. Registered on the 2nd of October 2014.

Highlights

With more patients in need of oncological care, there is a growing interest to transfer survivorship care from specialist to general practitioner (GP)
Patients who were surgically treated with curative intent for stage I-III colon cancer were considered eligible and randomly assigned into four groups comparing survivorship care by a surgeon to care by a general practitioner (GP), with or without access to a supporting eHealth application (Oncokompas)
The participating GPs delivered care for 16 patients who had a mean age of 65.7 years (SD 7.8), male sex (n = 9), stage II-III colon carcinoma (n = 10), received adjuvant chemotherapy (n = 3) and had access to Oncokompas (n = 9)

Summary

Introduction

With more patients in need of oncological care, there is a growing interest to transfer survivorship care from specialist to general practitioner (GP). The ongoing I CARE study was initiated in 2015 in the Netherlands to compare (usual) surgeon- to GP-led survivorship care, with or without access to a supporting eHealth application (Oncokompas). In the Netherlands all colon cancer patients remain in secondary care to receive survivorship care by a surgeon or specialised oncology nurse in the hospital. These uncertainties formed the basis for the I CARE study (Improving Care After colon canceR treatment in the Netherlands, personalised care to Enhance quality of life), comparing GP- to surgeon-led survivorship care for colon cancer patients, with or without access to a supporting e-Health application (Oncokompas) [11]. Within the first year after surgery, the I CARE study found no important differences in QoL changes between trial arms, demonstrating the potential of GPled survivorship care as an alternative to hospital-based care [12]

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