Continuity of care of colorectal cancer survivors at the end of treatment: the oncology–primary care interface

Purpose This study examines at a population level how colorectal cancer (CRC) survivors evaluate the continuity and quality of their follow-up care after treatment, particularly for those in the care of a primary care provider (PCP). Methods A survey was mailed in 2010 to all individuals in Manitoba...

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Bibliographic Details
Published in:Journal of cancer survivorship 2012-12, Vol.6 (4), p.468-475
Main Authors: Sisler, Jeffrey J., Taylor-Brown, Jill, Nugent, Zoann, Bell, Donna, Khawaja, Masud, Czaykowski, Piotr, Wirtzfeld, Debrah, Park, Jason, Ahmed, Shahida
Format: Article
Language:English
Subjects:
Aged
Canada - epidemiology
Carcinoma - epidemiology
Carcinoma - mortality
Carcinoma - psychology
Carcinoma - therapy
Colorectal cancer
Colorectal Neoplasms - epidemiology
Colorectal Neoplasms - mortality
Colorectal Neoplasms - psychology
Colorectal Neoplasms - therapy
Continuity of Patient Care - organization & administration
Continuity of Patient Care - standards
Continuity of Patient Care - statistics & numerical data
Female
Follow-Up Studies
Health Informatics
Health Promotion and Disease Prevention
Humans
Male
Medical Oncology - methods
Medical Oncology - organization & administration
Medical Oncology - standards
Medicine
Medicine & Public Health
Oncology
Patient Satisfaction
Perception
Primary care
Primary Care Medicine
Primary Health Care - methods
Primary Health Care - organization & administration
Primary Health Care - standards
Public Health
Quality of Life
Quality of Life Research
Surveys and Questionnaires
Survivor
Survivors - statistics & numerical data
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Summary:Purpose This study examines at a population level how colorectal cancer (CRC) survivors evaluate the continuity and quality of their follow-up care after treatment, particularly for those in the care of a primary care provider (PCP). Methods A survey was mailed in 2010 to all individuals in Manitoba, Canada diagnosed in 2008/2009 with stage II and III CRC. Respondents were asked to identify the main provider(s) of their follow-up care. Those indicating a PCP completed the Patient Continuity of Care Questionnaire (PCCQ), which assesses continuity of care upon discharge from hospital to community. Quality of life (QOL) on the Functional Assessment of Cancer Therapy—Colorectal (FACT-C) and the Illness Intrusiveness Rating Scale was collected as well as demographic information. Descriptive statistics and regression analyses were utilized. Results The response rate was 246/360 or 68.3 %. Most participants were Caucasian with a mean age of 70 and 18 months from diagnosis. A single “main provider” of follow-up care was named by 47 %, most frequently a FP or oncologist, but a majority (53 %) indicated multiple providers. Twenty-four combinations of providers were described. The 106 respondents (43.1 %) who named a PCP as a main provider completed the PCCQ and reported high scores on its five subscales. In multivariate analysis, lower FACT-C QOL scores (OR 2.72, CI 1.12–6.57) and male gender (OR 2.82, CI 1.11–7.18) predicted poorer evaluations of continuity of care. Concern was highest regarding sexual function, body image, fatigue, impact on work and recreation, and bowel control, and in those who were younger or with rectal cancer. Conclusions The organization of CRC follow-up care between providers is complex and variable, but patients followed by PCPs evaluate their transitions of care after treatment favorably. Specific clinical issues and higher risk groups are identified and may benefit from specific attention from all providers. Implications for cancer survivors Most CRC survivors are satisfied when their primary care provider becomes responsible for follow-up care. However, this is less true for those who are having more challenges in recovery. These survivors should ensure that information transfer and support services are identified that will smooth this transition.
ISSN:1932-2259
1932-2267
DOI:10.1007/s11764-012-0235-9