Involvement of Primary Care Physicians in the Decision Making and Care of Patients With Breast Cancer

Abstract

Collaborative care between cancer specialists and primary care providers (PCPs) may improve the delivery of high-quality cancer care. Yet, patient perspectives about how involved the PCPs were in their breast cancer care and treatment decisions remain unknown. Patients and MethodsA weighted random sample of women newly diagnosed with breast cancer in 2013 to 2014, as reported to the SEER registries in Los Angeles, California, and Georgia, were sent a survey approximately 6 months after diagnosis (N = 2,279, 71% response rate). The distributions of patientperceived PCP quality (six questions about PCP access and awareness of values) and the following three measures of patient-reported PCP involvement were assessed: how informed the respondent felt her PCP was about her breast cancer (engagement); how often the respondent talked with her PCP (communication); and how often the respondent felt the PCP participated in treatment decisions (participation). Adjusted mean scores of patient-reported satisfaction with and deliberation about the surgical treatment decision were then compared across levels of PCP engagement, communication, and participation using multivariable linear regression. ResultsThe majority of women in this sample perceived high PCP quality (63.6%), high PCP breast cancer engagement (66.2%), and high PCP communication (69.1%). More than a third of women (35.4%) reported that their PCP participated in their treatment decisions. Higher PCP engagement was associated with higher decision satisfaction when compared with low PCP engagement (adjusted P = .003). ConclusionPatient perceptions of PCP quality and PCP involvement in breast cancer care during treatment are high for most women, and PCPs often participate in breast cancer treatment decisions. However, PCP involvement did not lead to meaningful improvements in patients' appraisals of their decision making.

The Two Solitudes of Primary Care and Cancer Specialist Care: Is There a Bridge?

“…Although the received wisdom has always been that fps are not actively involved during those phases of cancer care, the data show other wise. A recent U.S. study reported similar findings 13 .…”

When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment

“…Third, non-response bias may have impacted our findings, as responders were more likely to be white men and received definitive treatment. With conflicting prior evidence 4,5 , the direction in which this would bias our findings on the association between PCP involvement and definitive treatment remains unclear. Fourth, patient self-report of discussions with their PCP could be susceptible to recall and social desirability bias, however, are similar to those reported in prior studies.…”

“…Patients perceived their primary care to be of high quality in the Wallner study, yet PCP engagement, communication and participation was not associated with improvement in meaningful deliberation of their treatment decisions. 5 Within this context, lack of association to differences in treatment patterns due to PCP involvement may reflect the limited influence of PCPs during treatment decision-making, a period in which cancer specialists' recommendations carry the most weight to patients. In our study, we also did not find PCP involvement in decision-making to be associated with different treatment patterns among men who may be least likely to benefit from definitive treatment including older men, men with limited life expectancies, and men with low risk disease.…”

“…Fourth, patient self-report of discussions with their PCP could be susceptible to recall and social desirability bias, however, are similar to those reported in prior studies. 5,20 Fifth, data was obtained from a single geographic area which may limit the generalizability of the study. However, the study area includes 5.3 million residents across urban and suburban locales.…”

“…4,5 Wallner and colleagues recently found that 35 percent of women with breast cancer reported a high level of PCP participation in their treatment decision, but this was not with linked with more meaningful deliberation for their treatment decision. 5 Jang and colleagues used cancer registry and Medicare claims data to evaluate how PCP visits relate to treatment choice, finding that 22% of men visited their PCP prior to their prostate cancer treatment and were more likely to receive conservative management. 4 However, this study used any visit with a PCP before treatment as identified in insurance claims as a proxy for treatment discussions and did not evaluate the effect amongst subgroups of men eligible for active surveillance.…”