title: 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.
authors.affiliation: Institut Bergonié, Comprehensive Cancer Centre, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France. fleur.delva@isped.u-bordeaux2.fr
authors.forename: Fleur
authors.initials: F
authors.lastname: Delva
authors.forename: Emilie
authors.initials: E
authors.lastname: Marien
authors.forename: Marianne
authors.initials: M
authors.lastname: Fonck
authors.forename: Muriel
authors.initials: M
authors.lastname: Rainfray
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Demeaux
authors.forename: Philippe
authors.initials: P
authors.lastname: Moreaud
authors.forename: Pierre
authors.initials: P
authors.lastname: Soubeyran
authors.forename: Annie J
authors.initials: AJ
authors.lastname: Sasco
authors.forename: Simone
authors.initials: S
authors.lastname: Mathoulin-Pélissier
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D058005:General Practitioners / Q000523:psychology / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000592:standards; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires