Patients' preferences for post-treatment breast cancer follow-up in primary care vs. secondary care: a qualitative study

Health Expect. 2015 Dec;18(6):2192-201. doi: 10.1111/hex.12189. Epub 2014 Mar 25.


Objective: To explore patients' preferences for follow-up in primary care vs. secondary care.

Methods: A cross-sectional design was employed, involving semi-structured interviews with 70 female patients with a history of early-stage breast cancer. Using descriptive content analysis, interview transcripts were analysed independently and thematically by two researchers.

Findings: Patients expressed the strongest preference for annual visits (31/68), a schedule with a decreasing frequency over time (27/68), and follow-up > 10 years, including lifelong follow-up (20/64). The majority (56/61) preferred to receive follow-up care from the same care provider over time, for reasons related to a personal doctor-patient relationship and the physician's knowledge of the patient's history. About 75% (43/56) preferred specialist follow-up to other follow-up models. However, primary care-based follow-up would be accepted by 57% (39/68) provided that there is good communication between GPs and specialists, and sufficient knowledge among GPs about follow-up. Perceived benefits of primary care-based follow-up referred to the personal nature of the GP-patient relationship and the easy access to primary care. Perceived barriers included limited oncology knowledge and skills, time available, motivation among GPs to provide follow-up care and patients' confidence with the present specialist follow-up.

Conclusions: More than half of the patients were open to primary care-based follow-up. Patients' confidence with this follow-up model may increase by using survivorship care plans to facilitate communication across the primary/secondary interface and with patients. Training GPs to improve their oncology knowledge and skills might also increase patients' confidence.

Keywords: breast cancer; follow-up; interviews; patients' preferences; primary care; qualitative study.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / psychology
  • Breast Neoplasms / therapy*
  • Continuity of Patient Care
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Interviews as Topic
  • Medical Oncology
  • Middle Aged
  • Netherlands
  • Patient Preference*
  • Physician-Patient Relations
  • Primary Health Care*
  • Qualitative Research
  • Secondary Care / methods*
  • Surveys and Questionnaires