title: Barriers to effective communication across the primary/secondary interface: examples from the ovarian cancer patient journey (a qualitative study).
abstract: Effective communication across the primary/secondary interface is vital for the planning and delivery of appropriate patient care throughout the cancer patient journey. This study describes GPs' views of the communication issues across the primary/secondary interface in relation to ovarian cancer patients using qualitative interviews with purposively sampled general practitioners (GPs) and an audit of hospital medical records of 30 deceased ovarian cancer patients. Issues raised by the GPs related to the content and format of communications, but of most concern was the tardiness. The time lag between dictation and typing letters ranged from 0 to 27 days, with a delay of up to 8 days for signing before transit through various mail systems to the GP. Three stages in the patient journey were characterized by particular issues: (1) in the pre-diagnostic and diagnostic stage was a need for prompt information regarding the results of tests and diagnoses, and clearer guidance on the use of tests and fast-track referrals; (2) in the active treatment phase, when GPs could lose touch with their patients, they needed effective communication in order to provide moral support and crisis management; and (3) when oncology withdrew and the focus of care switched back to the community for the terminal phase, GPs needed information to enable them to pick up the baton of care. There is a need to develop and evaluate interventions aimed at improving the content and speed of communications between secondary and primary care. Such interventions are likely to be complex and might include the greater use of telephone or fax for more selected communications, a review of secretarial support, the use of email, the development of GP designed proformas, the feasibility of patient/carer letter delivery options, nurse-led communication, universal electronic patient records, or a revisiting of the patient-held record.
authors.affiliation: Department of Palliative Care and Policy, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, UK. morag.farquhar@kcl.ac.uk
authors.forename: M C
authors.initials: MC
authors.lastname: Farquhar
authors.forename: S I G
authors.initials: SI
authors.lastname: Barclay
authors.forename: H
authors.initials: H
authors.lastname: Earl
authors.forename: G E
authors.initials: GE
authors.lastname: Grande
authors.forename: J
authors.initials: J
authors.lastname: Emery
authors.forename: R A F
authors.initials: RA
authors.lastname: Crawford
mesh_terms: D003144:Communication Barriers; D015709:Correspondence as Topic; D005194:Family Practice; D005260:Female; D006760:Hospitalization; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D016522:Oncology Service, Hospital / Q000458:organization & administration; D010051:Ovarian Neoplasms / Q000628:therapy*; D010351:Patient Discharge; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D016079:Refusal to Treat; D013997:Time Factors