‘Carrying on the way we are is becoming shambolic’ – An interview study with prostate cancer specialists about their usual practice of follow-up

Bulger, Jenna; Hiscock, Julia; Neal, Richard D; Stanciu, Andrei; Makin, Matthew; Wilkinson, Clare

doi:10.1177/2051415814545804

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…Conversely, there is controversy whether primary care based regimes are able to provide an effective follow-up service 20 . The findings of the current study highlighted that a significant proportion of patients following prostatectomy received insufficient follow-up when managed by primary health care service-based follow-up regimes.…”

Section: Discussionmentioning

confidence: 77%

Primary care follow-up of radical prostatectomy patients: A regional New Zealand experience

Yassaie

McLaughlin

Perera

et al. 2016

Prostate International

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BackgroundContemporary recommendations regarding the duration of follow-up after radical prostatectomy (RP) are highly heterogeneous. Protocol-based follow-up schemes have been implemented to facilitate the expeditious identification of patients with recurrence. The aim of this study is to assess the reliability and comfort of general practitioners (GPs) in follow-up of RP.MethodsFollowing institutional ethical approval, we performed a retrospective review in patients undergoing follow-up after RP between January 2004 and December 2010. Patient factors, disease variables, and follow-up prostate specific antigen (PSA) compliance was collected. “Noncompliant” follow-up care was defined as: patients that had not received a PSA for a 14 month period within 5 years of prostatectomy. Patient and disease-based risk factors for noncompliant follow-up were assessed. GPs were also surveyed in their follow-up practice of RP patients, to assess their familiarity in caring for these patients.ResultsIn total, 65 cases were identified that met the inclusion criteria. At 60 months of follow-up, 66% (43/65) of patients had a compliant follow-up regime. For patients with noncompliant follow-up at 60 months, median time of compliance did not differ significantly when assessing preoperative PSA, Gleason sum, extraprostatic extension, or surgical margin status. Of the GPs surveyed, 68% of GPs felt comfortable in follow-up of RP patients. Some 62% of GPs would expect the PSA to be < 0.1 and 25% of GPs would measure the PSA annually.ConclusionOur study identified that follow-up by GPs after RP is insufficient. Accordingly, there is a requirement for formal educational programs if primary care is to take a greater role in follow-up of these patients.

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Section: Discussionmentioning

confidence: 77%

Primary care follow-up of radical prostatectomy patients: A regional New Zealand experience

Yassaie

McLaughlin

Perera

et al. 2016

Prostate International

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“…The capacity of the traditional medical‐led model of long‐term follow‐up care for cancer has been increasingly regarded as inadequate and unsustainable (Bulger et al, ; Watson et al, ). As with other chronic conditions, the long‐term management of cancer treatment side‐effects is increasingly regarded as being best delivered by nurses, with specialist input provided when needed (Cockle‐Hearne et al, ; Jefford et al, ; Richardson, Griffin, Miller, & McNeil, ; Skolarus et al, ).…”

Section: Introductionmentioning

confidence: 99%

Trial of personalised care after treatment-Prostate cancer: A randomised feasibility trial of a nurse-led psycho-educational intervention

et al. 2018

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Objective The present parallel randomised control trial evaluated the feasibility of a nurse‐led psycho‐educational intervention aimed at improving the self‐management of prostate cancer survivors. Methods We identified 305 eligible patients from a district general hospital, diagnosed 9–48 months previously, who completed radical treatment, or were monitored clinically (ineligible for treatment). Ninety‐five patients were recruited by blinded selection and randomised to Intervention (N = 48) and Control (N = 47) groups. Participant allocation was revealed to patients and researchers after recruitment was completed. For 36 weeks, participants received augmented usual care (Control) or augmented usual care and additional nurse support (Intervention) provided in two community hospitals and a university clinic, or by telephone. Results Data from 91 participants (Intervention, N = 45; Control, N = 46) were analysed. All feasibility metrics met predefined targets: recruitment rate (31.15%; 95% CI: 25.95%–36.35%), attrition rate (9.47%; 95% CI: 3.58%–15.36%) and outcome measures completion rates (77%–92%). Forty‐five patients received the intervention, with no adverse events. The Extended Prostate Cancer Index Composite can inform the minimum sample size for a future effectiveness trial. The net intervention cost was £317 per patient. Conclusions The results supported the feasibility and acceptability of the intervention, suggesting that it should be evaluated in a fully powered trial to assess its effectiveness and cost‐effectiveness.

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“…Patients and urologists may not view the GP as knowledgeable on cancer and prefer follow-up at the hospital. 7,9 GPs may feel that they lack knowledge about cancer and follow-up requirements, and may face a high workload and lack of financial reward for additional tasks. 9…”

Section: Introductionmentioning

confidence: 99%

Feasibility and acceptability of follow-up for prostate cancer in primary care: a pilot study

Heins

Schellevis²,

Schotman

et al. 2018

BJGP Open

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BackgroundThe number of patients with prostate cancer is increasing, which puts additional pressure on health care. GP-led follow up may help reduce costs, travel time for patients, and workload for urologists and improve continuity of care.AimTo test the feasibility and acceptability of a new clinical pathway for GP-led prostate cancer follow-up.Design & settingA feasibility pilot study was performed in cooperation with six GP practices in the Dutch region of Amersfoort.MethodThe study included 20 patients with prostate cancer in a stable phase, who were aged ≥65 years and with comorbidity. Follow-up for prostate cancer was transferred to the GP for one year. Participating GPs and urologists jointly developed a protocol. Patient satisfaction was measured at 0 and 12 months with the ‘personalised care’ subscale of the Consumer Quality (CQ) index 'general practice care'. Next, patients, GPs, and urologists were interviewed about their experiences. The clinical pathway was considered successful if no patients were referred back to the urologist, except for an increase in prostate-specific antigen (PSA), and if the majority of patients and participating urologists and GPs were satisfied.ResultsOf the 20 patients included in the study, three were referred back to the urologist because of increasing PSA levels and one died (unrelated to prostate cancer). Most patients (73%) were satisfied with the transfer of care, indicated by a score of ≥3 on the ‘personalised care’ subscale. GPs and urologists had confidence in the ability of GPs to provide follow-up care and preferred to continue this.ConclusionThe new clinical pathway was successful, warranting a larger study to provide evidence for the (cost-)effectiveness of GP-led prostate cancer follow-up.

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‘Carrying on the way we are is becoming shambolic’ – An interview study with prostate cancer specialists about their usual practice of follow-up

Cited by 5 publications

References 17 publications

Primary care follow-up of radical prostatectomy patients: A regional New Zealand experience

Primary care follow-up of radical prostatectomy patients: A regional New Zealand experience

Trial of personalised care after treatment-Prostate cancer: A randomised feasibility trial of a nurse-led psycho-educational intervention

Feasibility and acceptability of follow-up for prostate cancer in primary care: a pilot study

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