Abstract
BackgroundColorectal cancer (CRC) survivors experience difficulty navigating complex care pathways. Sharing care between GPs and specialist services has been proposed to improve health outcomes in cancer survivors following hospital discharge. Culturally and Linguistically Diverse (CALD) groups are known to have poorer outcomes following cancer treatment but little is known about their perceptions of shared care following surgery for CRC. This study aimed to explore how non-English-speaking and English-speaking patients perceive care to be coordinated amongst various health practitioners.MethodsThis was a qualitative study using data from face to face semi-structured interviews and one focus group in a culturally diverse area of Sydney with non-English-speaking and English-speaking CRC survivors. Participants were recruited in community settings and were interviewed in English, Spanish or Vietnamese. Interviews were recorded, transcribed, and analysed by researchers fluent in those languages. Data were coded and analysed thematically.ResultsTwenty-two CRC survivors participated in the study. Participants from non-English-speaking and English-speaking groups described similar barriers to care, but non-English-speaking participants described additional communication difficulties and perceived discrimination. Non-English-speaking participants relied on family members and bilingual GPs for assistance with communication and care coordination. Factors that influenced the care pathways used by participants and how care was shared between the specialist and GP included patient and practitioner preference, accessibility, complexity of care needs, and requirements for assistance with understanding information and navigating the health system, that were particularly difficult for non-English-speaking CRC survivors.ConclusionsBoth non-English-speaking and English-speaking CRC survivors described a blend of specialist-led or GP-led care depending on the complexity of care required, informational needs, and how engaged and accessible they perceived the specialist or GP to be. Findings from this study highlight the role of the bilingual GP in assisting CALD participants to understand information and to navigate their care pathways following CRC surgery.
Highlights
Colorectal cancer (CRC) survivors experience difficulty navigating complex care pathways
A randomised controlled trial conducted in Australia comparing CRC follow up in general practice with surgical based follow-up showed no difference in patient satisfaction, detection of recurrence or mortality [8]
This study aimed to explore how CRC survivors from Culturally and Linguistically Diverse (CALD) backgrounds who speak languages other than English at home, as well as those from English-speaking backgrounds, perceive care to be coordinated amongst various health practitioners in an Australian setting
Summary
Colorectal cancer (CRC) survivors experience difficulty navigating complex care pathways. Sharing care between GPs and specialist services has been proposed to improve health outcomes in cancer survivors following hospital discharge. Cancer survivors have described multiple care needs following surgery, [4,5,6] and poor coordination of health care is a recurrent theme in cancer survivorship research [7]. Patients were satisfied overall with follow-up in primary care unless they had more challenges in recovery, when the organisation of care became “complex and variable” [12]. They valued support from an “active” GP, and reassurance from their specialists [13]. Concerns mentioned by GPs regarding participating in shared care for colorectal cancer survivors included time, cost, poor communication and inadequate transfer of information between specialist and GP settings [14,15,16]
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