General practitioners' ‘lived experience’ of assessing psychological distress in cancer patients: an exploratory qualitative study

Abstract

While psychological distress in cancer patients is common, little is known about how general practitioners (GPs) assess distress. Using semi-structured interviews, a phenomenological study of seven GPs was conducted to explore GPs' experiences of assessing distress. Findings revealed five themes: (1) Being in the Relay Team - receiving and passing the baton: where the assessment of distress was conceptualised as a relay baton passed between a team of health care professionals, with GPs most involved at diagnosis and in the palliative phase. (2) Being in a Relationship: where the doctor-patient relationship was described as a powerful facilitator to assessment. (3) Being Skilled: where GPs perceive they are skilled at assessment adopting a patient-centred approach. (4) Being Challenged - encountering barriers: challenges with assessment were identified regarding the GPs' own emotions, patient related factors and time; the duality of family as both barrier and facilitator was voiced. (5) The Intruder in the Room: where GPs did not use validated screening tools which were viewed as an intruder in the doctor-patient relationship. Further research to objectively assess GPs' skills in distress assessment and attitudes towards the use of screening tools within the cancer care context are merited.

What are the attitudes of health professionals regarding patient reported outcome measures (PROMs) in oncology practice? A mixed-method synthesis of the qualitative evidence

“…[49] (p11). Distress or embarrassment may also be experienced by staff administering the PROMs [30,33]. Only one study explored PROMs designed for Indigenous patients [56]; it highlighted the additional dimension of cultural sensitivity in the use of PROMs and professionals reported that the purpose-designed tool helped them to better connect with Indigenous patients [56].…”

“…Responding PROMs were viewed as generating a range of responses in patient management. Response strategies included: intervention where issues were identified [26,27,32,35,46]; adoption of a more holistic management approach [40,42,45,50]; modification of communication approaches [30,32,39,47,54,56]; and the promotion of patient self-management [44,53]. Study findings also raised the fear that PROMs could bring up issues for which no adequate response existed, particularly in relation to financial difficulties, psychological issues and fatigue [10,28,34,37]: I find it very hard to discuss finances with patients, especially when it comes to, "they say I'm not entitled to any benefits", and I'm thinking, "well I can't do anything about that unfortunately".…”

“…allied health) was cited as a key benefit of using PROMs [29, 30, 37, 43, 46, 48-50, 57, 58]. Some studies highlighted the importance of clarifying roles and responsibilities in order to coordinate the management of care, especially in relation to psychological and emotional issues [30,34,36,37,54,56]. For example, in a number of studies, oncologists and surgeons felt that nursing staff were better positioned to engage with psychosocial issues, and in some studies nursing staff agreed [10,26,28].…”

“…This was seen through comments such as "I think it's super helpful just to start conversations" and "It's opened the conversation for other things that may have been going on in their lives that we weren't seeing" [34] (p144). In contrast, other studies raised the possibility that the use of PROMs might actually stifle rapportbuilding and diminish the "human touch" within the interaction [28,30,31,33,35,37,54,58].…”

Living with cancer: challenges across the lifespan

“…). Carolan and Campbell () examine this issue from a GP perspective, and conclude we need to know more about GPs’ skills in distress assessment and attitudes towards screening instruments; a fruitful topic for further research.…”