title: Randomized Controlled Trial of Shared Care for Patients With Cancer Involving General Practitioners and Cancer Specialists.
abstract: OBJECTIVE
  We aimed to determine whether a shared care model (SCM) during chemotherapy treatment improved emotional well-being, empowerment, and prevalence of symptoms for people being treated for cancer.
  
  
  METHODS
  People receiving chemotherapy for hematologic, breast, ovarian, or colorectal malignancies at two cancer centers were randomly assigned to receive SCM or standard care. The SCM involved a patient-held record, a project coordinator, routine contact between the patient and general practitioner/primary care physician, and primary care physician education. Participants completed the Hospital Anxiety and Depression Scale, the Mini-Mental Adjustment to Cancer, and an empowerment questionnaire before, in the middle of, and on completion of chemotherapy. The presence and severity of adverse effects of chemotherapy were recorded by patients in a symptom diary.
  
  
  RESULTS
  Ninety-seven eligible participants were randomly allocated, less than half the intended recruitment. There were no significant differences between the groups for empowerment, symptom prevalence, or Mini-Mental Adjustment to Cancer scores. The proportion with clinical anxiety (Hospital Anxiety and Depression Scale anxiety score of ≥ 11) decreased over time in both groups (P = .013) but decreased more in the intervention group (P = .002). Depression was unchanged over time.
  
  
  CONCLUSIONS
  Our study was limited by low recruitment and predominance of patients with breast cancer, and was underpowered for the main analyses. Results should therefore be interpreted with caution. Little benefit was seen for SCM in the majority of domains including empowerment, symptom prevalence, and psychological adjustment to cancer. The SCM showed efficacy in clinically anxious patients. Such interventions may be better implemented by using a targeted approach to identify at-need subgroups.
authors.affiliation: The University of Western Australia; Harry Perkins Institute of Medical Research, The University of Western Australia; School of Primary, Aboriginal and Rural Health Care, The University of Western Australia; School of Medicine and Pharmacology, The University of Western Australia, Crawley; Royal Perth Hospital, Perth; General Practice and Primary Care Academic Centre, University of Melbourne, Carlton; Sir Charles Gairdner Hospital; Haematology Care Centre, Sir Charles Gairdner Hospital, Nedlands, Australia; and University of Oxford, Oxford, United Kingdom Claire.Johnson@uwa.edu.au.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Johnson
authors.affiliation: The University of Western Australia; Harry Perkins Institute of Medical Research, The University of Western Australia; School of Primary, Aboriginal and Rural Health Care, The University of Western Australia; School of Medicine and Pharmacology, The University of Western Australia, Crawley; Royal Perth Hospital, Perth; General Practice and Primary Care Academic Centre, University of Melbourne, Carlton; Sir Charles Gairdner Hospital; Haematology Care Centre, Sir Charles Gairdner Hospital, Nedlands, Australia; and University of Oxford, Oxford, United Kingdom.
authors.forename: Christobel M
authors.initials: CM
authors.lastname: Saunders
authors.affiliation: The University of Western Australia; Harry Perkins Institute of Medical Research, The University of Western Australia; School of Primary, Aboriginal and Rural Health Care, The University of Western Australia; School of Medicine and Pharmacology, The University of Western Australia, Crawley; Royal Perth Hospital, Perth; General Practice and Primary Care Academic Centre, University of Melbourne, Carlton; Sir Charles Gairdner Hospital; Haematology Care Centre, Sir Charles Gairdner Hospital, Nedlands, Australia; and University of Oxford, Oxford, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Phillips
authors.affiliation: The University of Western Australia; Harry Perkins Institute of Medical Research, The University of Western Australia; School of Primary, Aboriginal and Rural Health Care, The University of Western Australia; School of Medicine and Pharmacology, The University of Western Australia, Crawley; Royal Perth Hospital, Perth; General Practice and Primary Care Academic Centre, University of Melbourne, Carlton; Sir Charles Gairdner Hospital; Haematology Care Centre, Sir Charles Gairdner Hospital, Nedlands, Australia; and University of Oxford, Oxford, United Kingdom.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Emery
authors.affiliation: The University of Western Australia; Harry Perkins Institute of Medical Research, The University of Western Australia; School of Primary, Aboriginal and Rural Health Care, The University of Western Australia; School of Medicine and Pharmacology, The University of Western Australia, Crawley; Royal Perth Hospital, Perth; General Practice and Primary Care Academic Centre, University of Melbourne, Carlton; Sir Charles Gairdner Hospital; Haematology Care Centre, Sir Charles Gairdner Hospital, Nedlands, Australia; and University of Oxford, Oxford, United Kingdom.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Nowak
authors.affiliation: The University of Western Australia; Harry Perkins Institute of Medical Research, The University of Western Australia; School of Primary, Aboriginal and Rural Health Care, The University of Western Australia; School of Medicine and Pharmacology, The University of Western Australia, Crawley; Royal Perth Hospital, Perth; General Practice and Primary Care Academic Centre, University of Melbourne, Carlton; Sir Charles Gairdner Hospital; Haematology Care Centre, Sir Charles Gairdner Hospital, Nedlands, Australia; and University of Oxford, Oxford, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Overheu
authors.affiliation: The University of Western Australia; Harry Perkins Institute of Medical Research, The University of Western Australia; School of Primary, Aboriginal and Rural Health Care, The University of Western Australia; School of Medicine and Pharmacology, The University of Western Australia, Crawley; Royal Perth Hospital, Perth; General Practice and Primary Care Academic Centre, University of Melbourne, Carlton; Sir Charles Gairdner Hospital; Haematology Care Centre, Sir Charles Gairdner Hospital, Nedlands, Australia; and University of Oxford, Oxford, United Kingdom.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Ward
authors.affiliation: The University of Western Australia; Harry Perkins Institute of Medical Research, The University of Western Australia; School of Primary, Aboriginal and Rural Health Care, The University of Western Australia; School of Medicine and Pharmacology, The University of Western Australia, Crawley; Royal Perth Hospital, Perth; General Practice and Primary Care Academic Centre, University of Melbourne, Carlton; Sir Charles Gairdner Hospital; Haematology Care Centre, Sir Charles Gairdner Hospital, Nedlands, Australia; and University of Oxford, Oxford, United Kingdom.
authors.forename: David J L
authors.initials: DJ
authors.lastname: Joske
mesh_terms: D005260:Female; D058005:General Practitioners / Q000592:standards*; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000592:standards*