Who Is Responsible? The Role of Family Physicians in the Provision of Supportive Cancer Care

Abstract

Purpose: Patients living with cancer identify family physicians (FPs; ie, primary care physicians) as a preferred resource for supportive cancer care (SCC), either through direct provision or referral. However, little research exists on the specific role FPs play in addressing these needs. Methods:A mailed survey was sent to all FPs in a health care region in Ontario, Canada, to determine their current and preferred roles in the specific provision of SCC to patients with cancer who have been newly diagnosed or are at the end of life.Results: Completed surveys were received from 84 (64%) of 183 eligible FPs. Most practitioners reported providing for their patients' various SCC needs. However, clear gaps were demonstrated in psychosocial and nutritional counseling and in providing information about SCC services. FPs were satisfied with their current role reported in SCC coordination, although the type of role varied; FPs who were asked about their end-of-life patients tended to see themselves as part of coordinating teams, whereas FPs asked about their recently diagnosed patients were more likely to defer this responsibly to a third party. Conclusion:This study identified gaps in the provision of psychosocial and informational care to patients with cancer that may result in unmet needs. In general, FPs do not see themselves as primarily responsible for coordinating patients' SCC and do not wish to assume this role. Accordingly, models that involve FPs as team members in SCC coordination are more feasible for reducing patient need.

Cost Trajectories for Cancer Patients

“…An examination of models that could identify this group in advance could potentially inform interventions. Confirmed by the observation that increased continuity of care is likely to mitigate the risk of high-cost status after treatment, primary care involvement in the circle of care during cancer treatment has also been cited to be likely to lessen many of the challenges that arise when coordinating care for a patient with cancer 33,34 . Although the involvement of family physicians for cancer-related visits was not a significant predictor of cost after cancer for patients with low pre-cancer costs, such involvement was shown to be protective against high costs after cancer for patients with high pre-cancer costs.…”

“…The delivery of cancer care spans a longitudinally diverse range of providers and settings depending on the patient's journey, prognosis, and personal preferences, and care is often fragmented and poorly coordinated 33,35 . Given the complex and evolving nature of the needs of cancer patients [36][37][38] , the coordination of treatment between cancer-care and non-cancer-care providers is important not only during cancer treatment, but especially as patients transition out of the cancer system 34,36 .…”

Multidisciplinary Health Care Professionals' Perceptions of the Use and Utility of a Symptom Assessment System for Oncology Patients

“…Physicians play a key role in referring patients to other supportive care services, such as pain and symptom management clinics or psychological evaluations for depression. [21][22][23] Without a formalized initial assessment, supportive care needs of patients with cancer may remain unmet.…”

Differences Between Primary Care Physicians’ and Oncologists’ Knowledge, Attitudes and Practices Regarding the Care of Cancer Survivors

“…However, little is known about physician attitudes or other potential barriers to implementing these models. Prior physician surveys were either conducted outside the US [24][25][26][27] or in selected samples from academic centers 28 . There are also limited data on potential physician barriers reflecting US medical practices, such as deficits in knowledge and unfavorable attitudes towards shared care and other alternative models of cancer survivor care.…”