Black men are three times more likely to develop prostate cancer (PCa), to do so at a younger age and to experience a more aggressive form than White men. This study aims to understand the experiences of African-Caribbean men with respect to their discharge to primary care following successful PCa treatment and the challenges associated with survivorship. Design: Eight African-Caribbean men, who had been successfully treated for PCa, were recruited through the charity BME Cancer Communities. They participated in a focus group, which took place on the premises of the charity and was audio-recorded. The recording was transcribed and the data were analysed employing thematic analysis. Results: Three overarching themes were developed: Discharge-misconceptions and uncertainties; Survivorship-challenges and ways of coping; Black men and PCa: real and potential discrimination. Participants expressed concerns regarding the lack of information and clarity about what discharge meant, the quality of follow-up care, especially the levels of specialist knowledge among GPs, and the impact of side-effects, particularly erectile dysfunction (ED). Participants linked ED with stereotypes of Black male sexuality, particularly in relation to difficulties of expressing their emotions and psychological distress. African-Caribbean men face particular challenges in dealing with the side-effects of treatment for PCa, which are linked to socially-constructed ideas of masculinity. Conclusion: There needs to be a greater focus in primary care on understanding these issues and providing individualised culturally-sensitive care. In particular, GPs should be aware of sensitivities concerning help-seeking related to culturally-mediated understandings of masculinity.
Survival times for prostate cancer have increased substantially, meaning more survivors will be discharged to General Practitioners' (GP) services. The detection of recurrence and monitoring of symptoms and long-term side-effects in prostate cancer survivors requires the active involvement of GPs in their follow-up care. In order to address this, the transition and discharge from hospital to primary care must be managed effectively. The objective of this study was to examine the preparedness, concerns and experiences of GPs in relation to their role in providing follow-up care to prostate cancer survivors. Purposive sampling was used to recruit GPs with experience in providing care to prostate cancer survivors. Twenty semistructured telephone interviews were conducted with GPs across England. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Participants described their current role in the follow-up pathway, a number of challenges and barriers in assuming this role, and potential ways to resolve these and improve their involvement. They expressed a range of views about their preparedness and willingness to take over follow-up care after discharge for this group of patients. GPs had reservations about workload, lack of resources, expertise and deficiencies in communication with hospitals. Findings from this study suggest that GPs will be ready to take over the follow-up care of prostate cancer survivors if better information, additional training and adequate resources are provided and communication lines with hospital specialists are clear. Understanding the issues faced by GPs and overcoming identified barriers to providing follow-up care to prostate cancer survivors will
ObjectivesTo evaluate the cost, accessibility and patient satisfaction implications of two clinical pathways used in the management of chronic headache.InterventionManagement of chronic headache following referral from Primary Care that differed in the first appointment, either a Neurology appointment or an MRI brain scan.Design and settingA pragmatic, non-randomised, prospective, single-centre study at a Central Hospital in London.ParticipantsAdult patients with chronic headache referred from primary to secondary care.Primary and secondary outcome measuresParticipants’ use of healthcare services and costs were estimated using primary and secondary care databases and questionnaires quarterly up to 12 months postrecruitment. Cost analyses were compared using generalised linear models. Secondary outcomes assessed: access to care, patient satisfaction, headache burden and self-perceived quality of life using headache-specific (Migraine Disability Assessment Scale and Headache Impact Test) and a generic questionnaire (5-level EQ-5D).ResultsMean (SD) cost up to 6 months postrecruitment per participant was £578 (£420) for the Neurology group (n=128) and £245 (£172) for the MRI group (n=95), leading to an estimated mean cost difference of £333 (95% CI £253 to £413, p<0.001). The mean cost difference at 12 months increased to £518 (95% CI £401 to £637, p<0.001). When adjusted for baseline and follow-up imbalances between groups, this remained statistically significant. The utilisation of brain MRI improved access to care compared with the Neurology group (p<0.001). Participants in the Neurology group reported higher levels of satisfaction associated with the pathway and led to greater change in care management.ConclusionDirect referral to brain MRI from Primary Care led to cost-savings and quicker access to care but lower satisfaction levels when compared with referral to Neurology services. Further research into the use of brain MRI for a subset of patient population more likely to be reassured by a negative brain scan should be considered.Trial registration numberNCT02753933.
BackgroundLung cancer screening with low-dose computed tomography (LDCT) has been shown to decrease mortality. Low lung cancer survival rates in the UK, driven primarily by late-stage presentation, provide the impetus for implementing screening. Nascent guidance on screening in the UK recommends primary care case-finding. However, the potential impact and acceptability on primary care, and the opportunistic utilisation of other case-finding routes, such as pharmacies, smoking cessation services, and respiratory clinics, have not been fully explored.AimTo explore healthcare professionals’ views and perspectives about lung cancer screening and their preparedness and willingness to be involved in its implementation.Design & settingA qualitative study was carried out with semi-structured interviews conducted with GPs, pharmacists, staff from smoking cessation services within Southwark and Lambeth in London, and staff from respiratory clinics in Guys’ and St Thomas’ NHS Foundation Trust in London between April 2018 and December 2018.MethodSixteen participants were interviewed and the interview transcripts were analysed thematically.ResultsParticipants described lung cancer screening as an important diagnostic tool for capturing lung cancer at an earlier stage and in increasing survivorship. However, the majority expressed a lack of awareness and understanding, uncertainty and concerns about the validity of screening, and the potential impact on their patients and workload.ConclusionStudy participants had mixed opinions about lung cancer screening and expressed their concerns about its implementation. Addressing these concerns by providing resources and effective and detailed guidelines for their use may lead to greater engagement and willingness to be involved in lung cancer screening.
BackgroundLung cancer screening with low-dose CT has been shown to decrease mortality. Low lung cancer survival rates in the UK, driven primarily by late-stage presentation, provide the impetus for implementing screening. Nascent guidance on screening in the UK recommends primary care case-finding. However, the potential impact and acceptability on primary care, and the opportunistic utilisation of other case-finding routes such as pharmacies, smoking cessation services and respiratory clinics, have not been fully explored.AimTo explore healthcare professionals’ views and perspectives about lung cancer screening and their preparedness and willingness to be involved in its implementation.MethodA qualitative study was carried out with semi-structured interviews conducted with GPs, pharmacists and staff from smoking cessation services within Southwark and Lambeth and from respiratory clinics in Guy’s and St. Thomas’ NHS Trust in London in 2018. Sixteen participants were interviewed, and the interview transcripts were analysed thematically.ResultsParticipants described lung cancer screening as an important diagnostic tool for capturing lung cancer at an earlier stage and in increasing survivorship. However, the majority expressed a lack of awareness and understanding, uncertainty and concerns about the validity of screening, its misuse and the potential impact on their patients and workload.ConclusionStudy participants had mixed opinions about lung cancer screening and expressed their concerns about its implementation. Addressing these concerns by providing resources and effective and detailed guidelines for their use may lead to greater engagement and willingness to be involved in lung cancer screening.
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