title: Improving local services for women with breast cancer: interviews with general practitioners in central Sydney.
abstract: We conducted interviews with 85 randomly selected general practitioners (GPs) in Central Sydney to examine patterns of referral of women with breast cancer, satisfaction with local services, awareness of evidence-based guidelines and suggestions for local support. Previous experience was the most frequently cited factor influencing choice of specialist (n = 80, 94%) followed by personal knowledge of the consultant's expertise (n = 72, 85%). Only one third of respondents agreed women wanted to be more involved in choosing the specialist (n = 28, 33%). Of 79 women recently diagnosed with breast cancer, the majority (96%) had been referred to a male surgeon (n = 71, 96%). While only 35% of the GPs rated the care received by women with breast cancer in local facilities as 'excellent', significantly fewer rated communication between GPs and specialists as 'excellent' (35% v 19%, p < 0.01). Younger GPs were less likely to rate communication as 'excellent' compared with GPs aged 55 years or older (p = 0.01). Only 18% of GPs considered their patients as having been 'very well informed' about their treatment choices. Younger GPs were more likely than older GPs to recall all available breast cancer guidelines (p = 0.02). Significantly more GPs (68%) requested seminars with experts than any other types of educational support (p < 0.001). To improve outcomes for women with breast cancer, mechanisms to support communication between GPs and specialists are recommended. Seminars for GPs with experts who emphasize evidence-based guidelines should be funded and evaluated, especially for impact in meeting the needs of older GPs.
authors.affiliation: Needs Assessment & Health Outcomes Unit, Central Sydney Area Health Service, New South Wales.
authors.forename: J
authors.initials: J
authors.lastname: Ward
authors.forename: G
authors.initials: G
authors.lastname: Rikard-Bell
authors.forename: M
authors.initials: M
authors.lastname: Hobbs
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000628:therapy*; D003142:Communication; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009517:New South Wales; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D011897:Random Allocation; D012017:Referral and Consultation / Q000706:statistics & numerical data