Objective General practice plays an important role in cancer trajectories, and cancer patients request the continuous involvement of general practice. The objective of this scoping review was to identify healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective. Design, setting, and subjects A scoping review of the literature published in Danish or English from 2010 to 2020 was conducted. Data was collected using identified keywords and indexed terms in several databases (PubMed, MEDLINE, EBSCO CINAHL, Scopus, and ProQuest), contacting key experts, searching through reference lists, and reports from selected health political, research- and interest organizations’ websites. Main outcome measures We identified healthcare practices in cancer trajectories that increase quality care. Identified healthcare practices were grouped into four contextual domains and allocated to defined phases in the cancer trajectory. The results are presented according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR). Results A total of 45 peer-reviewed and six non-peer-reviewed articles and reports were included. Quality of care increases in all phases of the cancer trajectory when GPs listen carefully to the full story and use action plans. After diagnosis, quality of care increases when GPs and practice staff have a proactive care approach, act as interpreters of diagnosis, treatment options, and its consequences, and engage in care coordination with specialists in secondary care involving the patient. Conclusion This scoping review identified healthcare practices that increase the quality of care in cancer trajectories from a general practice perspective. The results support general practice in investigating own healthcare practices and identifying possibilities for quality improvement. KEY POINTS Identified healthcare practices in general practice that increase the quality of care in cancer trajectories: Listen carefully to the full story Use action plans and time-out-consultations Plan and provide proactive care Act as an interpreter of diagnosis, treatment options, and its consequences for the patient Coordinate care with specialists, patients, and caregivers with mutual respect Identified barriers for quality of care in cancer trajectories are: Time constraints in consultations Limited accessibility for patients and caregivers Health practices to increase the quality of care should be effective, safe, people-centered, timely, equitable, integrated, and efficient. These distinctions of quality of care, support general practice in investigat...
Background: Most cancer diagnostic pathways initiate from primary care and several factors affect the diagnostic processes. Aim: To analyse the associations between patient characteristics, symptom presentation and cancer type and the general practitioner’s (GP’s) assessment of the diagnostic processes. Design and setting: General practices in the North, Central, and Southern regions of Denmark were invited to participate in a questionnaire survey. Methods: Participating GPs received a list of incident cancer patients within a two-year period based on regional hospital data. A questionnaire was completed for each patient, addressing symptom presentation and the GP’s assessment of the diagnostic process both overall and in four subcategories (the patient’s, and the GP’s role, the transition between primary and secondary care, and the secondary sector’s role). Results: A total of 187 general practices informed on 8,240 patients. For 5,868 patients, diagnostic pathways started in general practice. Almost half (48%) presented with specific cancer symptoms. GPs assessed 56% and 32% of the diagnostic processes as “very good” and “predominantly good”, respectively; 12% were “predominantly poor” or “very poor”. Long symptom duration of 2+ months before GP contact and presenting with non-specific or a combination of non-specific and specific symptoms were associated with a poor overall assessment of the diagnostic process. Assessment in the four subcategories showed that the patient’s role was assessed less positively than the other three categories. Conclusion: A longer symptom duration and presenting without cancer-specific symptoms were associated with GPs assessing the diagnostic process as poor.
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