Dataset Information

Factors influencing general practitioners in the referral of elderly cancer patients.

ABSTRACT:

Background

A number of studies have identified advanced age as a barrier to accessing specialised oncological care. Many factors can influence the care provided for elderly patients after a diagnosis of cancer has been established or is suspected. Only one European study has analysed the decision processes leading general practitioners (GPs) to refer elderly patients with cancer to oncologists. The objectives of the current study are to describe the factors that influence these decisions and to identify the particular factors and GP characteristics that are associated with systematic referral of these patients in South-West France.

Methods

This is a cross-sectional study on a representative sample of GPs in Aquitaine, South-West France. Questionnaire items were selected using a Delphi consensus approach and sent by post. Two logistic regression models were constructed to investigate GPs' decisions to refer these patients.

Results

The response rate obtained was 30%. Half of the general practitioners reported "always" referring their elderly cancer patients to oncologists. More than 75% reported being influenced by patient-related elements (patient and/or family wishes, comorbid factors, unsuitability of invasive investigations, physical and mental autonomy), by cancer-related elements (severity of symptoms, expected side-effects) and an organisational element (whether the general practitioner was used to collaborating with oncologists). Logistic regression analysis showed that cancer site and organisational difficulties in patient management were significantly associated with the decision to refer elderly patients with early-stage cancer. For advanced stages, oncology training, patient age, organisational difficulties in patient management and stage of cancer were significantly associated with the decision to refer elderly patients.

Conclusions

Cancer-linked factors and organisational difficulties have been highlighted as influencing the decisions of GPs in the referral of elderly patients to a cancer team. These results highlight the need to implement continuous medical education specific for the management of elderly patients, to better apprehend the nature of these difficulties and to suggest solutions suited to local settings.

SUBMITTER: Delva F

PROVIDER: S-EPMC3024300 | biostudies-literature | 2011 Jan

REPOSITORIES: biostudies-literature

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Publications

Factors influencing general practitioners in the referral of elderly cancer patients.

Delva Fleur F Marien Emilie E Fonck Marianne M Rainfray Muriel M Demeaux Jean-Louis JL Moreaud Philippe P Soubeyran Pierre P Sasco Annie J AJ Mathoulin-Pélissier Simone S

BMC cancer 20110106

<h4>Background</h4>A number of studies have identified advanced age as a barrier to accessing specialised oncological care. Many factors can influence the care provided for elderly patients after a diagnosis of cancer has been established or is suspected. Only one European study has analysed the decision processes leading general practitioners (GPs) to refer elderly patients with cancer to oncologists. The objectives of the current study are to describe the factors that influence these decisions ...[more]

PMID: 21211031

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Project description:BackgroundEmergency Department attendance is increasing internationally, of which a significant proportion could be managed in general practice. In England, policies backed by substantial capital funding require such patients attending Emergency Departments be directed or 'streamed' to General Practitioners working in or parallel to Emergency Departments. However, evidence for streaming is limited and the processes of streaming patients attending Emergency Departments to General Practitioners lacks exploration.ObjectivesThis paper explores streaming to General Practitioners in and alongside Emergency Departments at ten sites across England. It highlights positive streaming practice, as well as issues that may contribute to poor streaming practice, in order to inform future service improvement.MethodsA longitudinal qualitative study was conducted with data collected between October 2017 and December 2019 across 10 case study sites throughout England as part of a broader mixed methods study. 186 non-participant observations and 226 semi-structured interviews with 191 health professionals working in Emergency Departments or related General Practitioner Services were thematically analysed in relation to streaming processes and experiences.ResultsSix interconnected themes influencing streaming were identified: implementing and maintaining structural support; developing and supporting streaming personnel; implementing workable and responsive streaming protocols; negotiating primary/secondary care boundaries; developing and maintaining interprofessional relationships and concerns for patient safety. Streaming was considered central to the success of General Practitioners in/parallel to Emergency Departments. The importance of the skills of streaming nurses in delivering an optimal and safety critical service was highlighted, as was the skillset of General Practitioners and interprofessional relationships between streamers and General Practitioners. There was no distinct streaming model or method associated with good streaming practice to General Practitioners in/alongside Emergency Departments, instead factors for success were identified and key recommendations suggested. 'Inappropriate' streaming was identified as a problem, where patients streamed to General Practitioners in or parallel to Emergency Departments required Emergency Department management, or patients suitable for General Practitioner care were kept in the Emergency Department.ConclusionDespite adopting differing methods, commonalities across case sites in the delivery of good streaming practice were identified, leading to identification of key recommendations which may inform development of streaming services.Study registrationISRCTN51780222. Tweetable abstract: Workplace culture and the skillset of streamers and General Practitioners is crucial to streaming of patients to General Practitioners in Emergency Departments.

Project description:BACKGROUND:Although death certificates (DCs) provide valuable health information which may help to guide local health policies and priorities, there is little information concerning their validity in Thailand. First-year general practitioners (GPs) have a major role in DC completion, especially in provincial general hospitals. The aim of this study was to evaluate the accuracy and factors influencing the accuracy of DCs completed by first-year GPs in Thailand, compared with the cause of death (COD) derived from medical records by experts. METHODS:This retrospective study was conducted at 14 provincial general hospitals in Thailand during the June 2011 to May 2012 study period. Medical records and DCs completed by first-year GPs who graduated from 16 Thai medical schools were sampled. The cause of death recorded on the DCs was compared with the medical conditions and histories derived from patient medical records. A cross-sectional survey of the 210 GPs who completed the DCs reviewed in this study was also conducted. Respondent GPs' demographic characteristics, factors associated with COD, and COD coding system were evaluated. RESULTS:Five hundred and sixty-three medical records and corresponding DCs were included. Of those, 36.9% of DCs were found to be correct. Common mistakes included incorrect sequence of events leading to death (32.4%), and mode of death use (26.2%). Of the 210 GPs, 155 questionnaires were completed and returned. The mean time spent on recording COD and completing DCs in the medical school curriculum was 2.1?±?0.9 h and only 27.7% of participants had experience in completing DCs by themselves during medical school. Mean medical school GPA was significantly higher in the correctly completed DC GPs group than in the incorrectly completed DC GPs group (3.3?±?0.4 vs. 3.2?±?0.3; p?=?0.03). However, no significant difference was found for other factors associated with COD between groups. CONCLUSIONS:This is the first study documenting gaps and disparities in DC accuracy, and factors influencing completion of DCs among first-year GPs in Thailand, based on a clinical assessment of medical records. GPs made errors on 63.1% of DCs. This finding suggests that proven education, system-related support, and additional training interventions specific to DC completion are required.

Dataset Information

Factors influencing general practitioners in the referral of elderly cancer patients.

Background

Methods

Results

Conclusions

Publications

Factors influencing general practitioners in the referral of elderly cancer patients.

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