Department of Geriatric Medicine, CHU Nimes, Univ Montpellier, Nîmes, France.
Department of General Medicine, Univ Montpellier, Montpellier, France; CEPS platform, site Saint-Charles, 34000 Montpellier, France; Maison de santé pluri-professionnelle universitaire Avicenne, 2 rue Ibn Sinai dit Avicenne, 66300 Cabestany, France; Institut Desbrest d'Epidemiologie et de Sante Publique, IDESP UMR UA11 INSERM - Univ. Montpellier, Montpellier, France.
J Geriatr Oncol. 2021 Sep;12(7):1076-1084. doi: 10.1016/j.jgo.2021.05.009. Epub 2021 May 25.
In France, general practitioners (GPs) are usually the first-line healthcare contact for breast cancer (BC) screening/diagnosis in older women, information about therapies, access to cancer specialists, management of comorbidities and follow-up. GPs' practices may influence the factors involved in the unfavorable prognosis of BC in older patients: delay in diagnosis, insufficiently active treatment and the impact of associated morbidities.
The aim of this study was to explore GPs' experience, to understand the factors which shape their care of older women with BC and to identify ways in which this care might be improved.
This was a two-part qualitative study among GPs following COREQ guidelines. We analysed themes arising from group and semi-directive personal interviews.
GPs had diverse attitudes caused by 1/ the GPs' professional values, in response to their mission for local referral, their overall knowledge of the patient's context and wishes; 2/ the impact of comorbidities; 3/ the GPs' own experiences (confrontation with the disease, emotional ties established with the patient, embarrassment about examinations); 4/ prejudicial connotations (therapies judged as being too aggressive). GPs expressed interest for training, for inclusion in a coordinated multidisciplinary organisation with oncologists and geriatricians, confirming the GP's position (to better inform their patients, participate in the therapeutic decision and ensure the continuity of care).
To improve their care of older patients with BC, GPs would welcome improved relationships with geriatricians and oncologists, more information support and a more clearly defined role in the geriatric oncology care pathway.
在法国，全科医生（GP）通常是老年女性乳腺癌（BC）筛查/诊断的一线医疗联系人，负责提供治疗信息、协助患者接触癌症专家、处理合并症并进行随访。GP 的实践可能会影响到老年患者 BC 预后不良的相关因素：诊断延迟、治疗不积极以及合并症的影响。
本研究旨在探讨 GP 的经验，了解影响其对老年 BC 女性患者护理的因素，并确定改善这种护理的方法。
这是一项遵循 COREQ 指南的 GP 两部分定性研究。我们分析了小组和半指导性个人访谈中出现的主题。
GP 有不同的态度，原因是：1/ GP 的职业价值观，以响应他们的基层转诊任务、对患者整体情况和意愿的了解；2/ 合并症的影响；3/ GP 自身的经验（与疾病的接触、与患者建立的情感联系、对检查的尴尬）；4/ 偏见的含义（被认为过于激进的治疗方法）。GP 对培训、纳入与肿瘤学家和老年病学家协调的多学科组织以及确认 GP 的地位（更好地为患者提供信息、参与治疗决策并确保护理的连续性）表示了兴趣。
为了改善对老年 BC 患者的护理，GP 欢迎与老年病学家和肿瘤学家建立更好的关系、获得更多的信息支持以及在老年肿瘤学护理路径中更明确的角色定位。
