General practitioners’ perceptions of their role in cancer follow-up care: A qualitative study in the Netherlands

Abstract

Background: In the last few decades there has been a considerable increase in the number of cancer survivors. Health policy makers would like to see cancer follow-up care moved from secondary to primary care. Method: Between 2008 and 2010, a qualitative study among primary health care professionals was performed to get more insight into the way they care for cancer survivors. Analysed was whether a coordinating role in cancer survivorship care would fit in with the practical logic underlying the way the general practitioners work. Results: In their everyday work, general practitioners are used to provide care in a reactive way. Based on this habitus, they classify their patients into ‘not special’ and ‘special’ ones. Since general practitioners label cancer survivors as ‘not special,’ they expect these patients to take the initiative to ask for help and present their complaints in a clear and complete way. Their habitus as a gatekeeper implies that they are reticent about referring patients to other primary health care professionals. In regard to ‘not special’ patients, such as cancer survivors, general practitioners appear to build on the patients’ own strengths.

Conclusion: The emphasis on a wait-and-see attitude in contemporary Dutch general practice, as well as the general practitioners’ role as a gatekeeper are at odds with the proactive and holistic approach inherent to a coordinating role in cancer follow-up. Therefore, we assume that it will be difficult for general practitioners to shape a pivotal role in this care.

Keywords::

• cancer follow-up care
• cancer survivor
• general practitioner
• logic of practice
• pivotal role

ACKNOWLEDGEMENTS

The authors should like to thank the professionals who participated in the research, and to the working group ‘Primary care for cancer survivors’ of the Cancer Signalling Commission of the KWF Dutch Cancer Society that facilitated the research. The research was financed by a subsidy from the KWF Dutch Cancer Society and is gratefully acknowledged.

Additional thanks go to Hannerieke van der Boom for performing a part of the interviews, and to Prof Klasien Horstman for her comments on previous versions of this article.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.