Are Primary Care Providers Prepared to Care for Survivors of Breast Cancer in the Safety Net?

被引:33
作者
Dawes, Aaron J. [1 ,2 ,3 ]
Hemmelgarn, Marian [4 ]
Nguyen, David K. [1 ]
Sacks, Greg D. [1 ,3 ]
Clayton, Sheilah M. [5 ,6 ]
Cope, Jacqueline R. [7 ,8 ]
Ganz, Patricia A. [9 ,10 ]
Maggard-Gibbons, Melinda [1 ,2 ,4 ]
机构
[1] Univ Calif Los Angeles, David Geffen Sch Med, Dept Surg, Los Angeles, CA 90095 USA
[2] VA Greater Los Angeles Healthcare Syst, Los Angeles, CA USA
[3] Univ Calif Los Angeles, Robert Wood Johnson Fdn, Clin Scholars Program, Los Angeles, CA USA
[4] Olive View Univ Calif Los Angeles, Med Ctr, Dept Surg, Sylmar, CA USA
[5] Martin Luther King Jr Charles R Drew Univ Med Ctr, Dept Med, Div Canc Res & Training, Los Angeles, CA USA
[6] Martin Luther King Jr Multi Serv Ambulatory Care, Los Angeles, CA USA
[7] Univ Calif Los Angeles, David Geffen Sch Med, Dept Family Med, Los Angeles, CA 90095 USA
[8] Los Angeles Cty Dept Hlth Serv, Ambulatory Care Network, Los Angeles, CA USA
[9] Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, Los Angeles, CA 90095 USA
[10] Univ Calif Los Angeles, Jonsson Comprehens Canc Ctr, Los Angeles, CA 90024 USA
基金
美国国家卫生研究院;
关键词
breast cancer; survivorship; safety-net providers; primary care physicians; QUALITY-OF-LIFE; TOP; 5; LIST; FOLLOW-UP; CLINICAL ONCOLOGY; AMERICAN SOCIETY; RANDOMIZED-TRIAL; PHYSICIANS; SURVEILLANCE; MAMMOGRAPHY; PLANS;
D O I
10.1002/cncr.29201
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUNDWith the growing number of survivors of breast cancer outpacing the capacity of oncology providers, there is pressure to transition patients back to primary care. Primary care providers (PCPs) working in safety-net settings may have less experience treating survivors, and little is known about their knowledge and views on survivorship care. The current study was performed to determine the knowledge, attitudes, and confidence of PCPs in the safety net at delivering care to survivors of breast cancer. METHODSA modified version of the National Cancer Institute's Survey of Physician Attitudes Regarding Care of Cancer Survivors was given to providers at 2 county hospitals and 5 associated clinics (59 providers). Focus groups were held to understand barriers to survivorship care. RESULTSAlthough the majority of providers believed PCPs have the skills necessary to provide cancer-related follow-up, the vast majority were not comfortable providing these services themselves. Providers were adherent to American Society of Clinical Oncology recommendations for mammography (98%) and physical examination (87%); less than one-third were guideline-concordant for laboratory testing and only 6 providers (10%) met all recommendations. PCPs universally requested additional training on clinical guidelines and the provision of written survivorship care plans before transfer. Concerns voiced in qualitative sessions included unfamiliarity with the management of endocrine therapy and confusion regarding who would be responsible for certain aspects of care. CONCLUSIONSSafety-net providers currently lack knowledge of and confidence in providing survivorship care to patients with breast cancer. Opportunities exist for additional training in evidence-based guidelines and improved coordination of care between PCPs and oncology specialists. Cancer 2015;121:1249-1256. (c) 2014 American Cancer Society. Primary care providers working in safety-net settings report low knowledge and confidence in their ability to care for survivors of breast cancer. Additional training concerning aspects of survivorship care, including compliance with American Society of Clinical Oncology guidelines, is needed before survivors can be successfully transitioned to primary care.
引用
收藏
页码:1249 / 1256
页数:8
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