Shared care involving cancer specialists and primary care providers – What do cancer survivors want?

Abstract

BackgroundCancer survivors are living longer, prompting greater focus on managing cancer as a chronic condition. Shared care between primary care providers (PCPs) and cancer specialists, involving explicit partnership in how care is communicated, could ensure effective transitions between services. However, little is known about cancer patients' and survivors' preferences regarding shared care.ObjectiveTo explore Australian cancer survivors' views on shared care: what cancer survivors need from shared care; enablers and barriers to advancing shared care; and what successful shared care looks like.Setting and ParticipantsCommunity forum held in Adelaide, Australia, in 2015 with 21 participants: 11 cancer survivors, 2 family caregivers, and 8 clinicians and researchers (members of PC4‐Primary Care Collaborative Cancer Clinical Trials Group).InterventionQualitative data from group discussion of the objectives.ResultsParticipants stressed that successful shared care required patients being at the centre, ensuring accurate communication, ownership, and access to their medical records. PCPs were perceived to lack skills and confidence to lead complex cancer care. Patients expressed burden in being responsible for navigating information sharing and communication processes between health professionals and services. Effective shared care should include: shared electronic health records, key individuals as care coordinators; case conferences; shared decision making; preparing patients for self‐management; building general practitioners' skills; and measuring outcomes.Discussion and ConclusionsThere was clear support for shared care but a lack of good examples to help guide it for this population. Recognizing cancer as a chronic condition requires a shift in how care is provided to these patients.

Assessing suitability for long-term colorectal cancer shared care: a scenario-based qualitative study

“…Patient-centred factors such as cancer survivors with higher cancer recurrence risk, complications from treatment, multiple cancer sites and changing treatment plans would benefit more from specialist reviews, but these should not prohibit the patient from participating in long term shared care. The importance of incorporating the preferences of cancer survivors into follow up care planning has also been found in previous studies and is the recommended approach to patient care [ 13 , 21 – 23 ]. Lawn and colleagues [ 13 ], through a community forum, similarly found strong desire for cancer survivors to be placed at the centre of their care to improve ownership and ensure accurate communication between the team members.…”

“…The role of general practice in cancer follow-up is not well defined and there is substantial variation on both cancer survivorship guidelines and practice in primary care [ 12 ]. Previous research by our team and others have highlighted concerns over primary care’s cancer-specific expertise and interest, time pressures in primary care, and survivors’ timely access to cancer services [ 10 , 13 ].…”

Barriers and facilitators to community‐based psycho‐oncology services: A qualitative study of health professionals’ attitudes to the feasibility and acceptability of a shared care model

“…Future research should explore the perspectives of patients with cancer, to facilitate implementation of these strategies. However, preliminary evidence suggests that shared care could be acceptable to patients with cancer …”

Promoting integrated care in prostate cancer through online prostate cancer-specific holistic needs assessment: a feasibility study in primary care

“…However, primary and secondary care services are often fragmented; with poor communication, lack of coordination, and role definition indicated as persistent problems [7]. Furthermore, patients living with and beyond cancer often report a desire to be actively involved in their care, but many feel excluded from care planning and shared decision making [8].…”

“…Holistic needs assessments (HNA) are recommended in the treatment and follow-up care for cancer and aim to provide a mechanism to help patients more easily identify and disclose their needs to healthcare professionals (HCPs), and aid the development of person-centred care plans. The sharing of care plans has been identified as a facilitator to improve communication and care coordination [8]. However, HNA are not routinely carried out during follow-up for men with prostate cancer.…”