Why are some patients in treatment for advanced cancer reluctant to consult their GP?

Abstract

Objectives. To analyse cancer patients’ views and perspectives on mechanisms and barriers to involving the GP in the late treatment phase of advanced cancer. Design. Qualitative, semi-structured interview study of 16 patients with advanced cancer and their next of kin. Seven patients were re-interviewed after six months and three after 12 months. Setting. Patients’ home in Region South, Denmark. Results. The cancer patients described how they developed a personal relationship with the staff at the cancer treatment centre. They also described some kind of dependability towards the hospital staff and therefore consulted the doctor or the staff at the cancer treatment centre before seeking advice from their GP. Some patients found that the GP was not familiar enough with the treatments given; others that they did not want to inconvenience the busy GP with what they perceived to be minor non-treatment-related matters. However, as the disease progressed they also described how they perceived unmet psychosocial needs. After ending chemotherapy, re-establishment of the contact between patient and GP was in this study dependent on a proactive attitude by the GP. Conclusion. GPs are important for cancer patients’ possibility of staying at home and dying at home. This study, however, shows that due to some patients’ barriers special attention is needed to guarantee the switch over from the cancer treatment centre to home-based end-of-life care. This is increasingly important as cancer patients to a still larger extent receive hospital-based, active treatment until shortly before death.

• Advanced cancer
• chemotherapy
• family practice
• gastrointestinal cancer
• patient–doctor relationship
• primary palliative care