Patient, primary care physician and specialist expectations of primary care physician involvement in cancer care

Abstract

Background: In Canada, many health authorities recommend that primary care physicians (PCP) stay involved throughout their patients' cancer journey to increase continuity of care. Few studies have focused on patient and physician expectations regarding PCP involvement in cancer care.

Objective: To compare lung cancer patient, PCP and specialist expectations regarding PCP involvement in coordination of care, emotional support, information transmission and symptom relief at the different phases of cancer.

Design: Canadian survey of lung cancer patients, PCPs and cancer specialists

Participants: A total of 395 patients completed questionnaires on their expectations regarding their PCP participation in several aspects of care, at different phases of their cancer. Also, 45 specialists and 232 community-based PCP involved in these patients' care responded to a mail survey on the same aspects of cancer care.

Results: Most specialists did not expect participation of the PCP in coordination of care in the diagnosis and treatment phases (65% and 78% respectively), in contrast with patients (83% and 85%) and PCPs (80% and 59%) (p < 0.0001). At these same phases, the best agreement among the 3 groups was around PCP role in emotional support: 84% and more of all groups had this expectation. PCP participation in symptom relief was another shared expectation, but more unanimously at the treatment phase (p = 0.85). In the advanced phase, most specialists expect a major role of PCP in all aspects of care (from 81% to 97%). Patients and PCP agree with them mainly for emotional support and information transmission.

Conclusion: Lung cancer patient, PCP and specialist expectations regarding PCP role differ with the phase of cancer and the specific aspect of cancer care. There is a need to reach a better agreement among them and to better define PCP role, in order to achieve more collaborative and integrated cancer care.

Figure 1

Patient participation in the study.

Figure 2

Comparison of Patient and PCP Perceptions regarding Pattern of Care at the Treatment Phase.

Figure 3

Comparison of Patient, PCP and Specialist Expectations regarding PCP Involvement at Different Phases of Cancer *: p value calculated with Chi square test at each phase to compare proportion of patients, PCPs and specialists who expect PCP involvement for each care aspect.