title: Proactive cancer care in primary care: a mixed-methods study.
abstract: BACKGROUND
  Current models of post-treatment cancer care are based on traditional practices and clinician preference rather than evidence of benefit.
  
  
  OBJECTIVE
  To assess the feasibility of using a structured template to provide holistic follow-up of patients in primary care from cancer diagnosis onwards.
  
  
  METHODS
  A two-phase mixed methods action research project. An electronic cancer ongoing review document (CORD) was first developed with patients and general practitioners, and used with patients with a new diagnosis of cancer. This was evaluated through documentary analysis of the CORDs, qualitative interviews with patients, family carers and health professionals and record reviews.
  
  
  RESULTS
  The records of 107 patients from 13 primary care teams were examined and 45 interviews conducted. The document was started in 54% of people with newly diagnosed cancer, and prompted clear documentation of multidimension needs and understanding. General practitioners found using the document helped to structure consultations and cover psychosocial areas, but they reported it needed to be better integrated in their medical records with computerized prompts in place. Few clinicians discussed the review openly with patients, and the template was often completed afterwards.
  
  
  CONCLUSIONS
  Anticipatory cancer care from diagnosis to cure or death, 'in primary care', is feasible in the U.K. and acceptable to patients, although there are barriers. The process promoted continuity of care and holism. A reliable system for proactive cancer care in general practice supported by hospital specialists may allow more survivorship care to be delivered in primary care, as in other long-term conditions.
authors: Primary Palliative Care Research Group, Centre for Population Health Sciences, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
authors: Marilyn
authors: M
authors: Kendall
authors: Bruce
authors: B
authors: Mason
authors: Natalie
authors: N
authors: Momen
authors: Stephen
authors: S
authors: Barclay
authors: Dan
authors: D
authors: Munday
authors: Roberta
authors: R
authors: Lovick
authors: Stella
authors: S
authors: Macpherson
authors: Euan
authors: E
authors: Paterson
authors: Paul
authors: P
authors: Baughan
authors: Paul
authors: P
authors: Cormie
authors: Peter
authors: P
authors: Kiehlmann
authors: Amanda
authors: A
authors: Free
authors: Scott A
authors: SA
authors: Murray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005194:Family Practice / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010358:Patient Participation / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*
keywords: Cancer care; chronic disease management; palliative care; primary care; user involvement.
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