‘Picking up the pieces’ - primary care practitioners’ experiences of cancer care reviews: a qualitative study

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

6A.3

Presenter:

Dipesh Gopal

Twitter:

@dipeshgopal @StephJCTaylor @pinguo1501 @NikolaosEfstat2

Co-authors:

Stephanie J. C. Taylor (1), Ping Guo (2), Nikolaos Efstathiou (2)

Author institutions:

1. Centre for Primary Care, Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner St, London E1 2AB, 2. School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT

Problem

One role of primary care in the UK is to deliver cancer care via financially incentivised conversations: ‘cancer care reviews’ (CCRs). There has been a smaller workforce, increased patient demand, and CCR policy changes alongside lack of research on CCRs since 2015. There is a need to explore how primary care staff deliver cancer care through CCRs, especially since the start of the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to explore primary care staff experiences with CCRs and identify their view of CCRs, how they conduct CCRs and their perceived value of CCRs.

Approach

An exploratory qualitative descriptive approach was used to collect data via remote semi-structured interviews with primary care staff after gaining informed consent. Interview transcripts were analysed using reflexive thematic analysis. Ethical approval was granted by the Health Research Authority (HRA, RG_22-039).

Findings

Fifteen primary care staff were interviewed [11 general practitioners (GPs), 3 practice nurses, and 1 physician associate]. Four themes were identified: 1) evolving perceptions of cancer; 2) complex delivery of cancer care reviews; 3) changes to cancer care review delivery during the COVID-19 pandemic; 4) ways to complement cancer care. Primary care staff identified the way that cancer was perceived which impacted how CCRs were delivered. Cancer care involves holistic care, helping decode jargon, signposting and providing unmet care needs. The COVID-19 pandemic resulted in remote CCR delivery. Staff suggested community cancer teams to provide cancer care alongside existing services.

Consequences

Financial incentives helped achieve a care standard and CCRs were a small part of how cancer care was delivered discretely throughout the year. Templates acted as a guide rather than a rigid structure as CCRs were tailored to patient needs. The COVID-19 pandemic affected cancer diagnosis and treatment, with some CCR delivery occurring remotely. Staff adopted the new 3- and 12-month format CCRs in response to the COVID-19 pandemic. Clinical training may benefit from better training on cancer as a long-term condition and how cancer is perceived by people from diverse ethnic backgrounds.

Submitted by:

Dipesh Gopal

Funding acknowledgement:

Dipesh Gopal is an In-Practice Fellow supported by the Department of Health and Social Care and the National Institute for Health and Care Research. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.