Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014, Copenhagen, Denmark.
BMC Fam Pract. 2019 Aug 27;20(1):119. doi: 10.1186/s12875-019-1009-5.
General practitioners (GPs) are responsible for managing chronic care in the growing population of patients with comorbid chronic conditions and cancer. Studies have shown, however, that cancer patients are less likely to receive appropriate chronic care compared to patients without cancer. Patients say that how GPs engage in the care of comorbidities influences their own priority of these conditions. No studies have explored GPs' attitudes to and prioritization of chronic care in patients who have completed primary cancer treatment. This study aims to explore GPs' experiences, prioritization of, and perspectives on treatment and follow-up of patients with cancer and comorbidity.
Semi-structured interviews were conducted during 2016 with 13 GPs in Region Zealand in Denmark. We used Systematic Text Condensation in the analysis.
All participating GPs said that chronic care in patients with a history of cancer was a high priority, and due to a clear structure in their practice, they experienced that few patients were lost to follow-up. Two different approaches to chronic care consultations were identified: one group of GPs described them as imitating outpatient clinics, where the GP sets the agenda and focuses on the chronic condition. The other group described an approach that was more attuned to the patient's agenda, which could mean that chronic care consultations served as an "alibi" for the patients to disclose other matters of concern. Both groups of GPs said that chronic care consultations for these patients supported normalcy, but in different ways. Some GPs said that offering future appointments in the chronic care process gave patients hope and a sense of normalcy. Other GPs strove for normalcy by focusing exclusively on the chronic condition and dealing with cancer as cured.
The participating GPs gave a high priority to chronic care in patients with a history of cancer. Some GPs, however, followed a rigorous agenda. GPs should be aware that a very focused and biomedical approach to chronic care might increase fragmentation of care and collide with a holistic and patient-centered approach. It could also affect GPs' self-perception of their role and the core values of general practice.
全科医生（GP）负责管理患有多种合并慢性疾病和癌症的患者群体的慢性疾病护理。然而，研究表明，与没有癌症的患者相比，癌症患者获得适当的慢性疾病护理的可能性较小。患者表示，全科医生在管理合并症方面的参与方式会影响他们自身对这些疾病的重视程度。目前尚无研究探讨全科医生在完成主要癌症治疗后对患有合并症的患者的慢性疾病护理的态度和优先事项。本研究旨在探讨全科医生对癌症合并症患者的治疗和随访的经验、重视程度和观点。
2016 年，在丹麦西兰大区对 13 名全科医生进行了半结构式访谈。我们在分析中使用了系统文本压缩。
所有参与研究的全科医生均表示，癌症患者的慢性疾病护理是重中之重，并且由于他们的实践中存在明确的结构，他们很少发现患者失访。确定了两种不同的慢性疾病护理咨询方法：一组全科医生将其描述为模仿门诊，即全科医生设定议程并专注于慢性疾病。另一组则描述了一种更能适应患者议程的方法，这可能意味着慢性疾病护理咨询成为患者披露其他关注事项的“借口”。两组全科医生都表示，这些患者的慢性疾病护理咨询支持常态，但方式不同。一些全科医生表示，在慢性疾病护理过程中提供未来的预约会给患者带来希望和正常感。其他全科医生则通过专注于慢性疾病并将癌症视为已治愈来追求常态。
参与研究的全科医生高度重视有癌症病史的患者的慢性疾病护理。然而，有些全科医生遵循严格的议程。全科医生应该意识到，对慢性疾病护理的非常专注和基于生物医学的方法可能会增加护理的碎片化，并与整体和以患者为中心的方法发生冲突。它还可能影响全科医生对自己角色的自我认知以及普通科医学的核心价值观。
