Understanding primary care-oncology relationships within a changing healthcare environment

Abstract

BackgroundManagement of care transitions from primary care into and out of oncology is critical for optimal care of cancer patients and cancer survivors. There is limited understanding of existing primary care-oncology relationships within the context of the changing health care environment.MethodsThrough a comparative case study of 14 innovative primary care practices throughout the United States (U.S.), we examined relationships between primary care and oncology settings to identify attributes contributing to strengthened relationships in diverse settings. Field researchers observed practices for 10–12 days, recording fieldnotes and conducting interviews. We created a reduced dataset of all text related to primary care-oncology relationships, and collaboratively identified patterns to characterize these relationships through an inductive “immersion/crystallization” analysis process.ResultsNine of the 14 practices discussed having either formal or informal primary care-oncology relationships. Nearly all formal primary care-oncology relationships were embedded within healthcare systems. The majority of private, independent practices had more informal relationships between individual primary care physicians and specific oncologists. Practices with formal relationships noted health system infrastructure that facilitates transfer of patient information and timely referrals. Practices with informal relationships described shared commitment, trust, and rapport with specific oncologists. Regardless of relationship type, challenges reported by primary care settings included lack of clarity about roles and responsibilities during cancer treatment and beyond.ConclusionsWith the rapid transformation of U.S. healthcare towards system ownership of primary care practices, efforts are needed to integrate strengths of informal primary care-oncology relationships in addition to formal system driven relationships.

Cancer survivorship care and general practice: A qualitative study of roles of general practice team members in Australia

“…This study confirms a number of previously identified concerns, including communication disparities resulting in an absence of role clarity between cancer specialists and GPs (Dossett et al., 2017; Easley et al, 2017; Lisy et al., 2020; Mitchell et al., 2012; Tsui et al, 2019), and a need for greater role clarity for PNs working in primary care (Aggar et al., 2016; Hohmann et al., 2020; McInnes et al., 2015, 2017; Yuille et al., 2016). Further, as previous studies highlighted, GPs indicated an interest in increasing their role in survivorship care (Lawrence et al., 2016).…”

Identification of an oncological clinical pathway through questionnaires to health professionals

“…The referral procedures from PHCs in our study differ with the results obtained by Tsui et al, in which their analysis of primary care and oncology relationships showed case studies of rural PHCs in the United States where most patients are referred to a regional hospital cancer center, thus following a pyramidal healthcare pathway [ 46 ]. Another study mapped cancer referral pathways in 10 countries and concluded that by analyzing the schematics and differences in referral processes further research could be prompted towards a better understanding on timeliness of diagnosis and cancer outcomes [ 47 ].…”

“…The lack of communication between professionals decreases primary care providers knowledge on their patients. As stated before, formal or informal communication systems that allow information transfer and facilitated bidirectional referrals have an advantage of increased rapport between providers in primary care and oncology settings [ 46 ]. These settings may be applicable in other contexts of primary care and other specialties co-managing different comorbidities [ 52 ].…”

American Cancer Society's report on the status of cancer disparities in the United States, 2021

“…The ACS has also funded >550 health equity research grants since 1999, including research on practice‐based tactics for overcoming barriers to accessing to care, inequities as the result of public policy and new cancer treatments, and the downstream effects of bias and discrimination based on factors such as age, sex, gender identity, race, ethnicity, literacy, geography, and SES 17,149,150 . In addition, the ACS has invested $29M in 2021 to support several new initiatives to increase diversity in the cancer workforce and advance heath equity research.…”