title: Coordination of cancer care between family physicians and cancer specialists: Importance of communication.
abstract: OBJECTIVE
  To explore health care provider (HCP) perspectives on the coordination of cancer care between FPs and cancer specialists.
  
  
  METHODS
  Qualitative study using semistructured telephone interviews.
  
  
  METHODS
  Canada.
  
  
  METHODS
  A total of 58 HCPs, comprising 21 FPs, 15 surgeons, 12 medical oncologists, 6 radiation oncologists, and 4 GPs in oncology.
  
  
  METHODS
  This qualitative study is nested within a larger mixed-methods program of research, CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum), focused on improving the coordination of cancer care between FPs and cancer specialists. Using a constructivist grounded theory approach, telephone interviews were conducted with HCPs involved in cancer care. Invitations to participate were sent to a purposive sample of HCPs based on medical specialty, sex, province or territory, and geographic location (urban or rural). A coding schema was developed by 4 team members; subsequently, 1 team member coded the remaining transcripts. The resulting themes were reviewed by the entire team and a summary of results was mailed to participants for review.
  
  
  RESULTS
  Communication challenges emerged as the most prominent theme. Five key related subthemes were identified around this core concept that occurred at both system and individual levels. System-level issues included delays in medical transcription, difficulties accessing patient information, and physicians not being copied on all reports. Individual-level issues included the lack of rapport between FPs and cancer specialists, and the lack of clearly defined and broadly communicated roles.
  
  
  CONCLUSIONS
  Effective and timely communication of medical information, as well as clearly defined roles for each provider, are essential to good coordination of care along the cancer care trajectory, particularly during transitions of care between cancer specialist and FP care. Despite advances in technology, substantial communication challenges still exist. This can lead to serious consequences that affect clinical decision making.
authors.affiliation: Research coordinator at the Dalhousie Family Medicine Teaching Unit in Fredericton, NB.
authors.forename: Julie
authors.initials: J
authors.lastname: Easley
authors.affiliation: Professor and Director of Research at the Dalhousie Family Medicine Teaching Unit in Fredericton. baukjemiedema@gmail.com.
authors.forename: Baukje
authors.initials: B
authors.lastname: Miedema
authors.affiliation: Family physician in the Granovsky Gluskin Family Medicine Centre at Mount Sinai Hospital in Toronto, Ont, and Clinician Scientist and Associate Professor in the Department of Family and Community Medicine at the University of Toronto.
authors.forename: June C
authors.initials: JC
authors.lastname: Carroll
authors.affiliation: Clinical Director of the Alberta Family Practice Research Network, Director of the Northern Alberta Primary Care Research Network, and Director of Research in the Department of Family Medicine at the University of Alberta in Edmonton.
authors.forename: Donna P
authors.initials: DP
authors.lastname: Manca
authors.affiliation: Assistant Professor in the Department of Family and Community Medicine at the University of Toronto and Scientific Associate with the Knowledge Translation Research Network, Health Services Research Program, and Ontario Institute for Cancer Research.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: O'Brien
authors.affiliation: Assistant Professor and Education Scientist in the Department of Family and Community Medicine at the University of Toronto, a fellow of the Centre for Critical Qualitative Health Research, and a cross-appointed scientist with the Wilson Centre.
authors.forename: Fiona
authors.initials: F
authors.lastname: Webster
authors.affiliation: Giblon Professor and Vice-Chair of Research in the Department of Family and Community Medicine at the University of Toronto and Director of Knowledge Translation Research in the Health Services Research Program at the Ontario Institute for Cancer Research.
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
mesh_terms: D002170:Canada; D003142:Communication; D003266:Continuity of Patient Care; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008495:Medical Oncology; D009369:Neoplasms / Q000628:therapy*; D010821:Physicians, Family; D036301:Qualitative Research; D013038:Specialization