Follow-up of curatively treated cancer in primary care: views of general practitioners

Abstract

Background: Follow-up for cancer typically occurs in secondary care, and improved survival has increased demands on these services. Other care models may alleviate this burden, such as moving (parts of) follow-up care for curatively treated patients from secondary to primary care (care substitution). Aim: We explored the opinions of general practitioners (GPs) regarding the potential benefits, barriers, and requirements of care substitution for breast and colorectal cancer. Design and Setting: A qualitative study of the opinions of purposively sampled GPs in Dutch primary care. Method: Focus group sessions and individual semi-structured interviews were recorded and transcribed verbatim. Data were analysed by two independent researchers using thematic analysis. Results: Two focus groups (n=14) were conducted followed by nine individual interviews. We identified three main themes: perceived benefits, perceived barriers, and perceived requirements. Perceived benefits included better accessibility and continuity of care, and care closer to patients’ homes. Uncertainty about cancer-related competences and practical objections were perceived as barriers. Requirements included close specialist collaboration, patients support, and stepwise implementation to avoid loss of existing care quality. Conclusion: Most GPs reported that they were not in favour of complete care substitution, but that primary care could have greater formal involvement in oncological follow-up if there is close collaboration with secondary care (i.e. shared-care), patient support, sufficient resource allocation, stepwise implementation with clear guidelines, and monitoring of quality. Clear and broadly supported protocols need to be developed and tested before implementing follow-up in primary care.