Abstract
BackgroundGeneral practitioners (GPs) are responsible for managing chronic care in the growing population of patients with comorbid chronic conditions and cancer. Studies have shown, however, that cancer patients are less likely to receive appropriate chronic care compared to patients without cancer. Patients say that how GPs engage in the care of comorbidities influences their own priority of these conditions. No studies have explored GPs’ attitudes to and prioritization of chronic care in patients who have completed primary cancer treatment. This study aims to explore GPs’ experiences, prioritization of, and perspectives on treatment and follow-up of patients with cancer and comorbidity.MethodsSemi-structured interviews were conducted during 2016 with 13 GPs in Region Zealand in Denmark. We used Systematic Text Condensation in the analysis.ResultsAll participating GPs said that chronic care in patients with a history of cancer was a high priority, and due to a clear structure in their practice, they experienced that few patients were lost to follow-up. Two different approaches to chronic care consultations were identified: one group of GPs described them as imitating outpatient clinics, where the GP sets the agenda and focuses on the chronic condition. The other group described an approach that was more attuned to the patient’s agenda, which could mean that chronic care consultations served as an “alibi” for the patients to disclose other matters of concern.Both groups of GPs said that chronic care consultations for these patients supported normalcy, but in different ways. Some GPs said that offering future appointments in the chronic care process gave patients hope and a sense of normalcy. Other GPs strove for normalcy by focusing exclusively on the chronic condition and dealing with cancer as cured.ConclusionsThe participating GPs gave a high priority to chronic care in patients with a history of cancer. Some GPs, however, followed a rigorous agenda. GPs should be aware that a very focused and biomedical approach to chronic care might increase fragmentation of care and collide with a holistic and patient-centered approach. It could also affect GPs’ self-perception of their role and the core values of general practice.
Highlights
General practitioners (GPs) are responsible for managing chronic care in the growing population of patients with comorbid chronic conditions and cancer
Advancing age is associated with an increased prevalence of cancer and comorbidity comprising chronic conditions such as diabetes (DM), cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD)
Other studies from the US and the UK have shown that patients with cancer and chronic conditions were less likely to receive preventive services and appropriate monitoring of e.g. Diabetes mellitus (DM), COPD and CVD compared to patients without cancer [15,16,17,18,19]
Summary
General practitioners (GPs) are responsible for managing chronic care in the growing population of patients with comorbid chronic conditions and cancer. That cancer patients are less likely to receive appropriate chronic care compared to patients without cancer. Patients with cancer and comorbidity have increased all-cause mortality compared to cancer patients without comorbidities [3,4,5,6,7] They are confronted with various challenges, for instance, the organization of care when treatment is shared between general practice and hospitals [8,9,10]. Other studies from the US and the UK have shown that patients with cancer and chronic conditions were less likely to receive preventive services and appropriate monitoring of e.g. DM, COPD and CVD compared to patients without cancer [15,16,17,18,19]
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