challenges to primary care and the community peninsula survivorship conference
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Challenges to primary care and the community Peninsula Survivorship Conference. Dr Peter Rose University Lecturer and GP. GP role in cancer. Then…. Prevention and screening Diagnosis and referral End of life. GP role in cancer. Now.. Cancer care review Agenda Does it happen? - PowerPoint PPT PresentationTRANSCRIPT
DEPARTMENT OF PRIMARY HEALTH CARE
July 21, 2011
Challenges to primary care and the community
Peninsula Survivorship Conference
Dr Peter Rose
University Lecturer and GP
July 21, 2011Peninsula cancer survivors Page 2
GP role in cancer
Then….
Prevention and screening
Diagnosis and referral
End of life
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GP role in cancer
Now..
Cancer care review Agenda Does it happen?
Earlier discharge
Longer survival Psycho-social Long term and late effects Co-morbidity
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Reasons for follow up
Detecting recurrence…but evidence for benefits of pre-symptomatic detection
Monitoring treatment and side effects
Support of patients and relatives Psychological Social Employment Signposting
Addressing information needs
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Reasons for follow up
BUT…
Different health professionals focus on different bits
Contact with GP variable The first stage is still hospital focussed
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The follow up pathway
Hospital alone +/- GP
Discharge
Patient alone +/- GP
A new care model
Aims of new model
Level 1 70% (now 10%)
Level 2 20% (now 90%)
Level 3 10% (Now <1%)
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Patient views
Who is a cancer survivor?
What is important to patients? Varies a lot….do we offer flexible approach E.g.Prostate cancer and treatment effects
Patient views on GP role Not an expert Lack knowledge Do not want to bother the doctor
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What information do patients get?
About the reasons for follow up Especially related to detection of recurrence
About the role of health professionals
About the choices they have
About where to get information
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Partners’ views
Become carers and health workers
Concerns about providing emotional support Recognising needs of patient while having their own
fears to cope with
Concerns about own health
Concerns about the future Looking out for signs of recurrence
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Partners’ views
Role of GP Would have like help but did not ask for it Issues of confidentiality
E Adams et al. Brookes University
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New inititatives
Earlier discharge means greater GP role Unless new model excludes GP But GP role not defined or formalised
Survivorship care plan
Risk stratification leading to new models of care
Risk stratification v needs
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What can primary care offer?
Care for physical, psychological and (some) social aspects of care
Care for co-morbidities, prevention and screening
Continuous longitudinal care
Co-ordination of care between patient and other agencies
Care for families
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What are the challenges?
In general…….
Specification of roles and responsibilities throughout follow up but acknowledge patient choice
Dedicated recall systems for follow up
Education and training Knowing what help we need and where to get
it………
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What are the challenges?
In particular….
Contact in the initial stages
Better use of the cancer care review
Contact at time of discharge
Flexibility Follow up those with ongoing needs or those who
choose continued contact
Better contact with families
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It is a big task!
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Thank you and questions
Acknowledgements
All the colleagues who have worked on these
projects with me but especially Eila Watson,
Nada Khan, Sian Harrison and Eike Adams