Factors influencing general practitioners in the referral of elderly cancer patients

详细信息    查看全文

• 作者：Fleur Delva (1) (5)
  Emilie Marien (1)
  Marianne Fonck (1)
  Muriel Rainfray (2) (3)
  Jean-Louis Demeaux (3)
  Philippe Moreaud (4)
  Pierre Soubeyran (1) (3)
  Annie J Sasco (3) (5)
  Simone Mathoulin-Pélissier (1) (3) (5)
  
• 刊名：BMC Cancer
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：11
• 期：1
• 全文大小：197KB
• 参考文献：1. Estimation de l'incidence et de la mortalité par cancer en France de 1978 à [http://www.invs.sante.fr/surveillance/cancers/estimations_cancers/default.htm] 2000.
  2. Fox SA, Roetzheim RG, Kington RS: Barriers to cancer prevention in the older person. / Clin Geriatr Med 1997, 13: 79-5.
  3. Jerant AF, Franks P, Jackson JE, Doescher MP: Age-related disparities in cancer screening: analysis of 2001 Behavioral Risk Factor Surveillance System data. / Ann Fam Med 2004, 2: 481-87. CrossRef
  4. Berendsen AJ, Benneker WH, Meyboom-de JB, Klazinga NS, Schuling J: Motives and preferences of general practitioners for new collaboration models with medical specialists: a qualitative study. / BMC Health Serv Res 2007, 7: 4. CrossRef
  5. Garasen H, Johnsen R: The quality of communication about older patients between hospital physicians and general practitioners: a panel study assessment. / BMC Health Serv Res 2007, 7: 133. CrossRef
  6. Monfardini S: What do we know on variables influencing clinical decision-making in elderly cancer patients? / Eur J Cancer 1996, 32A: 12-4. CrossRef
  7. Votron L, D'Hoore W, Swine C, Daisne JF, Scalliet P: The opinion of general practitioners on the treatment of prostate and breast cancer in elderly people: results of a survey based on clinical models. / Clin Oncol (R Coll Radiol) 2004, 16: 474-78.
  8. Fink A, Kosecoff J, Chassin M, Brook RH: Consensus methods: characteristics and guidelines for use. / Am J Public Health 1984, 74: 979-83. CrossRef
  9. Jones J, Hunter D: Consensus methods for medical and health services research. / BMJ 1995, 311: 376-80.
  10. Townsley CA, Naidoo K, Pond GR, Melnick W, Straus SE, Siu LL: Are older cancer patients being referred to oncologists? A mail questionnaire of Ontario primary care practitioners to evaluate their referral patterns. / J Clin Oncol 2003, 21: 4627-635. CrossRef
  11. Hosmer D, Lemeshow S: Model-building strategies and methods for logistic regression. In / Applied logistic regression. 2nd edition. Wiley; 2000:91-42. CrossRef
  12. Kurtz JE, Heitz D, Enderlin P, Imbert F, Nehme H, Bergerat JP, Dufour P: Geriatric oncology, general practitioners and specialists: Current opinions and unmet needs. / Crit Rev Oncol Hematol 2010, 75 (1) : 47-7. CrossRef
  13. Bain NS, Campbell NC, Ritchie LD, Cassidy J: Striking the right balance in colorectal cancer care--a qualitative study of rural and urban patients. / Fam Pract 2002, 19: 369-74. CrossRef
  14. Bouche G, Migeot V, Mathoulin-Pélissier S, Salamon R, Ingrand P: Breast cancer surgery: Do all patients want to go to high-volume hospitals? / Surgery 2008, 143 (6) : 699-05. CrossRef
  15. Sifer-Rivière L, Girre V, Gisselbrecht M, Saint-Jean O: Physician's perceptions of cancer care for elderly patients: A qualitative sociological study based on a pilot geriatric oncology program. / Crit Rev Oncol Hematol 2010, 75 (1) : 58-9. CrossRef
  16. Grunfeld J: Recommandations pour le Plan Cancer 2009-013. [http://www.e-cancer.fr/component/docman/doc_download/2466-rapportgrunfeld104pgessrmmars2009v3pdf]
  17. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2407/11/5/prepub
  
• 作者单位：Fleur Delva (1) (5)
  Emilie Marien (1)
  Marianne Fonck (1)
  Muriel Rainfray (2) (3)
  Jean-Louis Demeaux (3)
  Philippe Moreaud (4)
  Pierre Soubeyran (1) (3)
  Annie J Sasco (3) (5)
  Simone Mathoulin-Pélissier (1) (3) (5)
  
  1. Institut Bergonié, Comprehensive Cancer Centre, 229 cours de l’Argonne, 33076, Bordeaux Cedex, France
  5. Inserm U897, Equipe d’Epidémiologie pour la prévention des Cancers and CIC-EC 7, Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076, Bordeaux, France
  2. CHU Xavier Arnozan, Avenue du Haut-Lévêque, 33604, Pessac Cedex, France
  3. Université Victor Segalen, Bordeaux 2, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France
  4. Union Régionale des Médecins Libéraux d’Aquitaine, 105 rue Belleville, 33074, Bordeaux Cedex, France
  
• ISSN：1471-2407

文摘

Background A number of studies have identified advanced age as a barrier to accessing specialised oncological care. Many factors can influence the care provided for elderly patients after a diagnosis of cancer has been established or is suspected. Only one European study has analysed the decision processes leading general practitioners (GPs) to refer elderly patients with cancer to oncologists. The objectives of the current study are to describe the factors that influence these decisions and to identify the particular factors and GP characteristics that are associated with systematic referral of these patients in South-West France. Methods This is a cross-sectional study on a representative sample of GPs in Aquitaine, South-West France. Questionnaire items were selected using a Delphi consensus approach and sent by post. Two logistic regression models were constructed to investigate GPs' decisions to refer these patients. Results The response rate obtained was 30%. Half of the general practitioners reported "always" referring their elderly cancer patients to oncologists. More than 75% reported being influenced by patient-related elements (patient and/or family wishes, comorbid factors, unsuitability of invasive investigations, physical and mental autonomy), by cancer-related elements (severity of symptoms, expected side-effects) and an organisational element (whether the general practitioner was used to collaborating with oncologists). Logistic regression analysis showed that cancer site and organisational difficulties in patient management were significantly associated with the decision to refer elderly patients with early-stage cancer. For advanced stages, oncology training, patient age, organisational difficulties in patient management and stage of cancer were significantly associated with the decision to refer elderly patients. Conclusions Cancer-linked factors and organisational difficulties have been highlighted as influencing the decisions of GPs in the referral of elderly patients to a cancer team. These results highlight the need to implement continuous medical education specific for the management of elderly patients, to better apprehend the nature of these difficulties and to suggest solutions suited to local settings.