Abstract
BackgroundA number of studies have identified advanced age as a barrier to accessing specialised oncological care. Many factors can influence the care provided for elderly patients after a diagnosis of cancer has been established or is suspected. Only one European study has analysed the decision processes leading general practitioners (GPs) to refer elderly patients with cancer to oncologists. The objectives of the current study are to describe the factors that influence these decisions and to identify the particular factors and GP characteristics that are associated with systematic referral of these patients in South-West France.MethodsThis is a cross-sectional study on a representative sample of GPs in Aquitaine, South-West France. Questionnaire items were selected using a Delphi consensus approach and sent by post. Two logistic regression models were constructed to investigate GPs' decisions to refer these patients.ResultsThe response rate obtained was 30%. Half of the general practitioners reported "always" referring their elderly cancer patients to oncologists. More than 75% reported being influenced by patient-related elements (patient and/or family wishes, comorbid factors, unsuitability of invasive investigations, physical and mental autonomy), by cancer-related elements (severity of symptoms, expected side-effects) and an organisational element (whether the general practitioner was used to collaborating with oncologists). Logistic regression analysis showed that cancer site and organisational difficulties in patient management were significantly associated with the decision to refer elderly patients with early-stage cancer. For advanced stages, oncology training, patient age, organisational difficulties in patient management and stage of cancer were significantly associated with the decision to refer elderly patients.ConclusionsCancer-linked factors and organisational difficulties have been highlighted as influencing the decisions of GPs in the referral of elderly patients to a cancer team. These results highlight the need to implement continuous medical education specific for the management of elderly patients, to better apprehend the nature of these difficulties and to suggest solutions suited to local settings.
Highlights
A number of studies have identified advanced age as a barrier to accessing specialised oncological care
The detailed objectives of the study were to: 1) estimate the proportion of general practitioners (GPs) who refer their patients according to cancer stage, 2) identify factors associated with this decision among influential elements and individual GP characteristics, and 3) use two clinical case vignettes to identify the factors influencing GPs in clinical situations in their decision to refer an elderly patient presenting with cancer to specialised care
Section C explored any training received by the GPs in oncology or geriatrics, and the perception they had of the way elderly cancer patients are cared for in France
Summary
A number of studies have identified advanced age as a barrier to accessing specialised oncological care. The objectives of the current study are to describe the factors that influence these decisions and to identify the particular factors and GP characteristics that are associated with systematic referral of these patients in South-West France. The main aim of this study was to describe the factors influencing GPs in South-West France (Aquitaine) in their decisions whether or not to refer elderly cancer patients to oncology teams, using a cross sectional design. The detailed objectives of the study were to: 1) estimate the proportion of GPs who refer their patients according to cancer stage (early or advanced), 2) identify factors associated with this decision among influential elements and individual GP characteristics, and 3) use two clinical case vignettes to identify the factors influencing GPs in clinical situations in their decision to refer an elderly patient presenting with cancer to specialised care
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