General practitioners' role in cancer care: a French-Norwegian study

Lise Demagny,Tommy Thorsen,Janine Bachimont,Knut Holtedahl,Alain Letourmy,Martine Bungener

doi:10.1186/1756-0500-2-200

Abstract

BackgroundIn cancer care, a GP's work is rarely defined clearly. Our aim was to assess GPs' work with cancer patients in France and in Norway, where the roles of the GP and the organization of the system are rather different.FindingsA questionnaire with 40 closed-ended questions about GP involvement in diagnosis, treatment, follow-up and terminal care was constructed and mailed to samples of GPs. The patients had seen the doctor at least once over the past year. In France 1679 and in Norway 386 individual patient questionnaires were completed. GPs have a major role in the diagnosis of cancer, and this role varies according to cancer type. The GPs participated actively in different phases of follow-up after cancer treatment. Low response rates do not allow direct comparison between countries, but higher PSA screening rates in France seem to increase the percentage of patients diagnosed after screening rather than after a clinical suspicion. Interaction between GPs and specialists during cancer treatment and follow-up was important in both countries.ConclusionBoth in France and in Norway GPs participate actively in cancer care. Early clinical diagnosis is a challenge. More research is needed about how GPs can improve their early diagnostic work. Organisational issues may influence cancer responsibilities for the GP, and national health systems should be challenged to look at possible new roles for GPs in cancer care. Medical training, both pre- and post-graduate, should prepare doctors for collaboration between primary and secondary care, particularly important in cancer care.

Highlights

In cancer care, a General practitioner (GP)'s work is rarely defined clearly
To collect data about cancer patients, we gathered a panel of European GPs to develop the questionnaire based on information about individual patients available in medical records, and which could be filled in by the GP
Recall bias has been reduced by the use of medical records when the information was reported, and the internal validity seems to be satisfactory in that the answers give a rather comprehensive picture of what French and Norwegian GPs do in cancer care

Summary

Introduction

A GP's work is rarely defined clearly. Our aim was to assess GPs'work with cancer patients in France and in Norway, where the roles of the GP and the organization of the system are rather different. A GP's work is rarely defined clearly. Work with cancer patients in France and in Norway, where the roles of the GP and the organization of the system are rather different. Diagnosis [1,2,3], follow-up [4,5] and palliative care fall within the responsibility of the GP. In France and Norway, patients are free to choose their doctor, but in Norway the gatekeeper role of the GP is more pronounced and the circuit of medical professionals and health care institutions is more predetermined, depending on the patient's problem. We studied the diagnostic and therapeutic responsibility sphere of the GPs in the two countries with regard to cancer.

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Conclusion