Improving local services for women with breast cancer: interviews with general practitioners in central Sydney.

Abstract

We conducted interviews with 85 randomly selected general practitioners (GPs) in Central Sydney to examine patterns of referral of women with breast cancer, satisfaction with local services, awareness of evidence-based guidelines and suggestions for local support. Previous experience was the most frequently cited factor influencing choice of specialist (n = 80, 94%) followed by personal knowledge of the consultant's expertise (n = 72, 85%). Only one third of respondents agreed women wanted to be more involved in choosing the specialist (n = 28, 33%). Of 79 women recently diagnosed with breast cancer, the majority (96%) had been referred to a male surgeon (n = 71, 96%). While only 35% of the GPs rated the care received by women with breast cancer in local facilities as 'excellent', significantly fewer rated communication between GPs and specialists as 'excellent' (35% v 19%, p < 0.01). Younger GPs were less likely to rate communication as 'excellent' compared with GPs aged 55 years or older (p = 0.01). Only 18% of GPs considered their patients as having been 'very well informed' about their treatment choices. Younger GPs were more likely than older GPs to recall all available breast cancer guidelines (p = 0.02). Significantly more GPs (68%) requested seminars with experts than any other types of educational support (p < 0.001). To improve outcomes for women with breast cancer, mechanisms to support communication between GPs and specialists are recommended. Seminars for GPs with experts who emphasize evidence-based guidelines should be funded and evaluated, especially for impact in meeting the needs of older GPs.