Implementing a service users' framework for cancer care in primary care: an action research study.
BACKGROUND
We previously facilitated the development of a service-user designed framework for providing proactive care for people with cancer in the community.


OBJECTIVE
To validate this framework in clinical practice.


METHODS
We used an action research approach, helping five diverse general practices in the South of Scotland to implement the care framework. The process and outcomes were evaluated using in-depth interviews (18 patients and their family carers and 49 health professionals), participant observation and an ongoing dialogue between the practices, the research team and the original user groups.


RESULTS
Practices implemented the framework in a variety of ways. In general, they used their own customized cancer register to improve communication within the practice and began to offer proactive care from a diagnosis of cancer, not just when the disease became advanced. Local innovations included an intranet-based register, information sheets and regular multidisciplinary meetings. Patients, family carers and professionals suggested that the framework had helped achieve continuity of care, teamwork, proactive care and improved support and information for patients and carers.


CONCLUSIONS
Proactive personalized care can be improved in primary care for patients with cancer and their family carers through flexible adoption of a framework to embrace key characteristics of good care, as perceived by patients and carers, throughout the illness. Practices can achieve this by choosing approaches suited to their setting, experiences, structure and resources.
Murray
Scott A
SA
Primary Palliative Care Research Group, School of Clinical Sciences and Community Health-General Practice, University of Edinburgh, Edinburgh EH8 9DX, UK. scott.murray@ed.ac.uk
Boyd
Kirsty
K
Campbell
Christine
C
Cormie
Paul
P
Thomas
Keri
K
Weller
David
D
Kendall
Marilyn
M
D017028:Caregivers / Q000523:psychology; D019058:Community Networks; D005194:Family Practice; D006282:Health Personnel / Q000523:psychology; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D009369:Neoplasms / Q000628:therapy*; D010361:Patients / Q000523:psychology; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D012042:Registries; D012606:Scotland