The role of the general practitioner in the care for patients with colorectal cancer

In dit proefschrift wordt de rol van de huisarts in de zorg voor patiënten met dikke darmkanker beschreven, om daarmee de discussie over de organisatie van de oncologische zorg in Nederland te informeren. Huisartsen zijn, als poortwachter tot specialistische zorg, betrokken bij de diagnose darmkanker. Uit dit proefschrift blijkt dat het diagnostisch traject in sommige gevallen langer duurt. Dat komt doordat patiënten lang wachten met het melden van symptomen, maar ook doordat huisartsen klachten toeschrijven aan al bestaande aandoeningen of bijwerkingen van medicatie. Huisartsen blijven soms ook lang vasthouden aan eerder gestelde diagnoses. Daarnaast blijkt uit dit proefschrift dat de huisarts betrokken blijft bij zorg voor patiënten met darmkanker in het eerste jaar na diagnose en tijdens nacontroles. Patiënten worden door hun huisarts behandeld voor bijwerkingen van de therapie, krijgen leefstijl- en medisch advies en psychosociale ondersteuning. Hoewel patiënten de rol van de huisarts waarderen hebben de meeste voorkeur voor veel testen en nacontroles in het ziekenhuis. Patiënten geven aan continuïteit in deze zorg erg belangrijk te vinden. Omdat de huisarts al een grote rol speelt voor patiënten met darmkanker zouden nacontroles mogelijk kunnen worden geïntegreerd in deze zorg, met name als nacontroles minder afhankelijk worden van beeldvormende technieken. Goede ondersteuning voor huisartsen, zoals richtlijnen, scholing en goede communicatie met de tweede lijn is dan van belang. Bovendien moeten er evidence-based protocollen voor deze zorg ontwikkeld worden

Implementatie van gepersonaliseerd beweegprogramma bij patiënten na kanker

Bewegen is gezond, ook voor patiënten die kanker hebben gehad. Helaas beweegt het merendeel van deze patiënten nog onvoldoende. Leefstijlbegeleiding in de eerste lijn zou veel patiënten kunnen bereiken. Daarom bekijkt de afdeling Huisartsgeneeskunde en Ouderengeneeskunde van het UMC Groningen de implementatie van een laagdrempelig en gepersonaliseerd beweegprogramma in de huisartsenpraktijk: het SoDA-onderzoek (Stimulation of Daily Activities)

Care for mental well-being of cancer patients:Support during and after primary treatment

Item does not contain fulltextCancer is associated with sometimes strong emotions. However, emotions are mostly adaptive - they help people adapt to cancer. Adaptive emotions do not need to be treated; instead, emotional support is key. Professional mental health care is indicated only when emotions are no longer adaptive. Oncologists, nurses, and especially general practitioners play an important role in identifying people who qualify for referral to mental health care. Prior mental health problems, a weak social support system, and a relatively stressful disease course or treatment are risk factors for cancer-related emotional problems. Training and the development of professional networks can contribute to optimizing the availability, accessibility and quality of supportive care for mental well-being during and after cancer treatment. In addition, providing good information to patients is important, to enable them to find supportive care

Improving Care for Patients Living with Prolonged Incurable Cancer

SIMPLE SUMMARY: Not all patient with cancer can be cured. However, some patients with incurable cancer may expect to live for a substantial period of time. The number of patients in this group is increasing. These patients with ‘prolonged incurable cancer’ are often overlooked in research and clinical practice. They may have questions related to palliative care (e.g., about the end of life) and related to survivorship care (e.g., about late treatment effects). By itself, a palliative or survivorship perspective may therefore be insufficient to cover the wide range of physical and psychosocial problems that patients with prolonged incurable cancer encounter. Elements from both fields should therefore be delivered concordantly. This proposed new care model can further optimize care pathways for these patients. Furthermore, enhanced clinical awareness for this patient population as well as further research are urgently needed. ABSTRACT: The number of patients that can no longer be cured but may expect to live with their cancer diagnosis for a substantial period is increasing. These patients with ‘prolonged incurable cancer’ are often overlooked in research and clinical practice. Patients encounter problems that are traditionally seen from a palliative or survivorship perspective but this may be insufficient to cover the wide range of physical and psychosocial problems that patients with prolonged incurable cancer may encounter. Elements from both fields should, therefore, be delivered concordantly to further optimize care pathways for these patients. Furthermore, to ensure future high-quality care for this important patient population, enhanced clinical awareness, as well as further research, are urgently needed

Follow-up of curatively treated cancer in primary care:a qualitative study of the views of Dutch GPs

BACKGROUND: Follow-up for cancer typically occurs in secondary care, and improved survival has increased demands on these services. Other care models may alleviate this burden, such as moving (parts of) follow-up care for curatively treated patients from secondary to primary care (care substitution). AIM: To explore the opinions of GPs regarding the potential benefits, barriers, and requirements of care substitution for breast and colorectal cancer. DESIGN AND SETTING: A qualitative study of the opinions of purposively sampled GPs in Dutch primary care. METHOD: Focus group sessions and individual semi-structured interviews were recorded and transcribed verbatim. Data were analysed by two independent researchers using thematic analysis. RESULTS: Two focus groups (n = 14) were conducted followed by nine individual interviews. Three main themes were identified: perceived benefits, perceived barriers, and perceived requirements. Perceived benefits included better accessibility and continuity of care, and care closer to patients' homes. Uncertainty about cancer-related competences and practical objections were perceived as barriers. Requirements included close specialist collaboration, support from patients for this change, and stepwise implementation to avoid loss of existing care quality. CONCLUSION: Most GPs reported that they were not in favour of complete care substitution, but that primary care could have greater formal involvement in oncological follow-up if there is close collaboration with secondary care (that is, shared care), support from patients, sufficient resource allocation, stepwise implementation with clear guidelines, and monitoring of quality. Clear and broadly supported protocols need to be developed and tested before implementing follow-up in primary care

Increased primary health care use in the first year after colorectal cancer diagnosis

OBJECTIVE: The view that the general practitioner (GP) should be more involved during the curative treatment of cancer is gaining support. This study aimed to assess the current role of the GP during treatment of patients with colorectal cancer (CRC). DESIGN: Historical prospective study, using primary care data from two cohorts. SETTING: Registration Network Groningen (RNG) consisting of 18 GPs in three group practices with a dynamic population of about 30,000 patients. SUBJECTS: Patients who underwent curative treatment for CRC (n = 124) and matched primary care patients without CRC (reference population; n = 358). MAIN OUTCOME MEASURES: Primary healthcare use in the period 1998-2009. FINDINGS: Patients with CRC had higher primary healthcare use in the year after diagnosis compared with the reference population. After correction for age, gender, and consultation behaviour, CRC patients had 54% (range 23-92%) more face-to-face contacts, 68% (range 36-108%) more drug prescriptions, and 35% (range -4-90%) more referrals compared with reference patients. Patients consulted their GP more often for reasons related to anaemia, abdominal pain, constipation, skin problems, and urinary infections. GPs also prescribed more acid reflux drugs, laxatives, anti-anaemic preparations, analgesics, and psycholeptics for CRC patients. CONCLUSIONS: The GP plays a significant role in the year after CRC diagnosis. This role may be associated with treatment-related side effects and psychological problems. Formal guidelines on the involvement of the GP during CRC treatment might ensure more effective allocation and communication of care between primary and secondary healthcare services

Patient experiences during the COVID-19 pandemic:A qualitative study in Dutch primary care

Background Changes in primary care provision during the COVID-19 pandemic could have affected patient experience of primary care both positively and negatively. Aim To assess the experiences of patients in primary care during the COVID-19 pandemic. Design & setting A qualitative study of patients from regions with high and low COVID-19 prevalence in the Netherlands. Method A qualitative study using a phenomenological framework was performed among purposively sampled patients. Individual semi-structured interviews were performed and transcribed. Data were thematically analysed by means of an inductive approach. Results Twenty-eight patients were interviewed (13 men and 15 women, aged 27–91 years). After thematic analysis, two main themes emerged: accessibility and continuity of primary care. Changes considered positive during the pandemic regarding accessibility and continuity of primary care included having a quieter practice, having more time for consultations, and the use of remote care for problems with low complexity. However, patients also experienced decreases in both care accessibility and continuity, such as feeling unwelcome, the GP postponing chronic care, seeing unfamiliar doctors, and care being segregated. Conclusion Despite bringing several benefits, patients indicated that the changes to primary care provision during the COVID-19 pandemic could have threatened care accessibility and continuity, which are core values of primary care. These insights can guide primary care provision not only in this and future pandemics, but also when implementing permanent changes to care provision in primary care