French general practitioners' attitude towards breast cancer in older women: A qualitative study

Abstract

IntroductionIn France, general practitioners (GPs) are usually the first-line healthcare contact for breast cancer (BC) screening/diagnosis in older women, information about therapies, access to cancer specialists, management of comorbidities and follow-up. GPs' practices may influence the factors involved in the unfavorable prognosis of BC in older patients: delay in diagnosis, insufficiently active treatment and the impact of associated morbidities. ObjectiveThe aim of this study was to explore GPs' experience, to understand the factors which shape their care of older women with BC and to identify ways in which this care might be improved. MethodThis was a two-part qualitative study among GPs following COREQ guidelines. We analysed themes arising from group and semi-directive personal interviews. ResultsGPs had diverse attitudes caused by 1/ the GPs' professional values, in response to their mission for local referral, their overall knowledge of the patient's context and wishes; 2/ the impact of comorbidities; 3/ the GPs' own experiences (confrontation with the disease, emotional ties established with the patient, embarrassment about examinations); 4/ prejudicial connotations (therapies judged as being too aggressive). GPs expressed interest for training, for inclusion in a coordinated multidisciplinary organisation with oncologists and geriatricians, confirming the GP's position (to better inform their patients, participate in the therapeutic decision and ensure the continuity of care). ConclusionTo improve their care of older patients with BC, GPs would welcome improved relationships with geriatricians and oncologists, more information support and a more clearly defined role in the geriatric oncology care pathway.