French general practitioners’ sense of isolation in the management of elderly cancer patients

Chicoulaa, Bruno; Balardy, L.; Stillmunkès, André; Mourey, Loïc; Oustric, Stéphane; Bugat, Marie-Ève Rougé

doi:10.1093/fampra/cmw034

Cited by 17 publications

(19 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…GPs are often portrayed as if they were working solo with their palliative patients [ 15 ]; however, GPs often prefer to work in local palliative teams with nurses and other trusted care providers, if available [ 11 , 16 ]. Hierarchical doctor-nurse relationships might persist in such teams [ 17 ], but not always [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Teamwork in primary palliative care: general practitioners’ and specialised oncology nurses’ complementary competencies

Johansen

Ervik

2018

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundGeneralists such as general practitioners and district nurses have been the main actors in community palliative care in Norway. Specialised oncology nurses with postgraduate palliative training are increasingly becoming involved. There is little research on their contribution. This study explores how general practitioners (GPs) and oncology nurses (ONs) experience their collaboration in primary palliative care.MethodsA qualitative focus group and interview study in rural Northern Norway, involving 52 health professionals. Five uni-professional focus group discussions were followed by five interprofessional discussions and six individual interviews. Transcripts were analysed thematically.ResultsThe ideal cooperation between GPs and ONs was as a “meeting of experts” with complementary competencies. GPs drew on their generalist backgrounds, including their often long-term relationship with and knowledge of the patient. The ONs contributed longitudinal clinical observations and used their specialised knowledge to make treatment suggestions. While ONs were often experienced and many had developed a form of pattern recognition, they needed GPs’ competencies for complex clinical judgements. However, ONs sometimes lacked timely advice from GPs, and could feel left alone with sick patients. To avoid this, some ONs bypassed GPs and contacted palliative specialists directly.While traditional professional hierarchies were not a barrier, we found that organization, funding and remuneration were significant barriers to cooperation. GPs often did not have time to meet with ONs to discuss shared patients. We also found that ONs and GPs had different strategies for learning. While ONs belonged to a networking nursing collective aiming for continuous quality improvement, GPs learned mostly from their individual experience of caring for patients.ConclusionsThe complementary competences and autonomous roles of a specialised nurse and a general practitioner represented a good match for primary palliative care. When planning high-quality teamwork in primary care, organizational barriers to cooperation and different cultures for learning need consideration.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-2955-7) contains supplementary material, which is available to authorized users.

show abstract

Section: Introductionmentioning

confidence: 99%

Teamwork in primary palliative care: general practitioners’ and specialised oncology nurses’ complementary competencies

Johansen

Ervik

2018

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…The Deaf have difficulty accessing medical information including a communication barrier with the practitioner and a lack of education and interpreters [ 5 , 9 , 10 ]. In addition; difficulties of communications remain between general practitioners and oncologists [ 38 ]. Exams such as mammography and Papanicolau examination are not understood as well by the Deaf although they undergo these tests as often as people with hearing [ 10 , 26 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of cancers’ diagnostic stage in a Deaf community - survey about 4363 Deaf patients recorded in French units

Druel

Hayet²,

Esman³

et al. 2018

BMC Cancer

View full text Add to dashboard Cite

BackgroundDeaf people represent 0.1% of the French population and their access to public health campaigns is limited due to their frequent illiteracy and the infrequent use of sign language in campaigns. There is also a lack of general health knowledge in spite of the existence of French Deaf Care Units (UASS). The aim of this study is to assess the average diagnostic stage of cancer in the Deaf Community and discuss deafness as a contributing factor.MethodsFour thousand three hundred sixty-three Deaf patients recorded in five UASS, 80 diagnosed between 2005/01/01 and 2014/12/31 were selected from medical records and/or ICD-10 coding. Data regarding cancers were extracted, grouped by stage and compared to literature. Statistical significance was tested with Fisher’s Exact Test.ResultsEighty patients were selected. Most cancers were diagnosed at advanced stages: of 11 prostate cancers, 46% were locally advanced and 18% were metastatic. (In the general population, this was respectively 3% and 10.4% (p < 0.01)). Of six colorectal cancers, 67% were diagnosed at stage III and 33% at stage IV. (Respectively 20.6% and 26.6% (p = 0.03) in the general population). In contrast, of the 15 breast cancers, 93% were diagnosed at stages T1-T3 that was earlier than in the general population (p = 0.43).ConclusionIn this study, we observed a delay cancer diagnosis among Deaf people. Complicated and/or non-systematic screening procedures for cancers would be involved. Which is most likely the result of many factors (communication, medical knowledge). Increasing UASS coverage and health information campaigns in sign language could assist in earlier cancer diagnosis.

show abstract

“…Several qualitative studies have been published on patients' perceptions of their cancer management [29], their relationship with the healthcare team [30] and their interest in medical education [31,32]. Other studies have examined the perceptions of healthcare teams on their patients' treatment [33][34][35]. These studies revealed a number of factors leading to communication di culties between the patient, the oncologist and the GP.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…The literature shows that GPs believe that there is room for improvement in their communication with oncologists [23,45]. Although deeply involved in the management of patients with cancer, GPs feel isolated at crucial moments of the illness, and when making decisions at these times [33]. Many studies [12,13,17,20,45] reported unsatisfactory communication between GPs and oncologists.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Improving communication between the general practitioner and the oncologist: a key role in coordinating care for patients suffering from cancer.

Druel

Gimenez

Paricaud³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Patients suffering from cancers are increasingly numerous in general practice consultations. The General Practitioner (GP) should be at the heart of the management of patients. Several studies have examined the perceptions of GPs confronted with the patient suffering from cancer and the relationships of GPs with oncologists, but few studies have focused on the patients’ perspective. We studied the three-way relationship between the oncologist, the GP, and the patient, from the patient’s point of view. Methods: A questionnaire validated by a group consisting of GPs, oncologists, nurses, an epidemiologist and quality analyst, was administered over a three-week period to patients suffering from cancer receiving chemotherapy in a day hospital. Results: The analysis was based on 403 questionnaires. Patients had confidence in the GP’s knowledge of oncology in 88 % of cases; 49 % consulted their GP for pain, 15 % for cancer-related advice, and 44 % in emergencies. Perceived good GP/oncologist communication led patients to turn increasingly to their GP for cancer-related consultations (RR = 1.14; p = 0.01) and gave patients confidence in the GP’s ability to manage cancer-related problems (RR = 1.30; p < 0.01). Mention by the oncologist of the GP’s role increased the consultations for complications (RR = 1.82; p < 0.01) as well as recourse to the GP in an emergency (RR = 1.35; p < 0.01). Conclusion: Patients suffering from cancer considered that the GP was competent, but did not often consult their GP for cancer-related problems. There is a discrepancy between patients’ beliefs and their behaviour. When the oncologist spoke to patients of the GP’s role, patients had recourse to their GP more often. Systematically integrating a GP consultation to conclude cancer diagnosis disclosure, could improve management and care coordination.

show abstract

French general practitioners’ sense of isolation in the management of elderly cancer patients

Cited by 17 publications

References 21 publications

Teamwork in primary palliative care: general practitioners’ and specialised oncology nurses’ complementary competencies

Teamwork in primary palliative care: general practitioners’ and specialised oncology nurses’ complementary competencies

Assessment of cancers’ diagnostic stage in a Deaf community - survey about 4363 Deaf patients recorded in French units

Improving communication between the general practitioner and the oncologist: a key role in coordinating care for patients suffering from cancer.

Contact Info

Product

Resources

About