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

Abstract

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.

Challenges of general practitioner-oncologist interaction in end-of-life communication: a qualitative study

“…Uncertainty about what was said exactly by the oncologists appears as an additional stressor as this information is not documented or communicated most of the time. Several studies underline not only the GPs' need to receive adequate and timely information from the hospital team but also the often ineffective communication that leads to disruptive care coordination [19,20,21]. As in our study, speci cally EOL-topics and the content of respective conversations are rarely a subject of interdisciplinary interaction and the patient often nds himself in the role of intermediary [9].…”

“…Sometimes we nd it out when talking to the patient." [GP 8,21] GPs express different opinions when deliberating on which mode of interaction with oncologists about EOL-communication could be the most appropriate. Some state that written information is enough, including digital options.…”

Ressenti des patients atteints de cancer en soins palliatifs exclusifs: vers un binôme médecin généraliste, cancérologue?

“…Cette mauvaise collaboration est connue des patients et des cancérologues et pourrait impacter négativement la prise en charge des patients [33]. Plusieurs études mettent en évidence la faible intégration des médecins généralistes dans les prises en charge oncologiques, avec des répercussions notables sur la qualité des soins et la morbi-mortalité [34][35][36]. L'amélioration de cette collaboration au stade curatif a des effets positifs.…”

Developing personalized survivorship care pathways in the United States: Existing resources and remaining challenges

“…A successful shift to self‐management for low‐complexity survivors will require substantial cultural shifts in how and by whom survivorship care is managed. Systematically integrating PCP consultation throughout the course of cancer care may improve the transition following treatment completion by developing a foundational relationship between the PCP and the survivor 31,37,38 . Additionally, there may be ways for oncologists to keep in touch with low‐complexity patients for the psychological well‐being of both patients and providers without managing their care and thus contributing to barriers to care for new patients.…”