Primary care and communication in shared cancer care: a qualitative study

Abstract

Objective: To explore perceptions of primary care physicians' (PCPs') and oncologists' roles, responsibilities, and patterns of communication related to shared cancer care in 3 integrated health systems that used electronic health records.

Study design: Qualitative study.

Methods: We conducted semistructured interviews with 10 patients having early-stage colorectal cancer and with 14 oncologists and PCPs. Sample sizes were determined by thematic saturation. Dominant themes and codes were identified and subsequently applied to all transcripts.

Results: Physicians reported that electronic health records improved communication within integrated systems but that communication with physicians outside of their system was still difficult. Primary care physicians expressed uncertainty about their role during cancer care, although medical oncologists emphasized the importance of comorbidity control during cancer treatment. Patients and physicians described additional roles for PCPs, including psychological distress support and behavior modification counseling.

Conclusions: Integrated systems that use electronic health records likely facilitate shared cancer care through improved PCP-oncologist communication. However, strategies to promote a more active role for PCPs in managing comorbidities, psychological distress, and behavior modification, as well as to overcome communication challenges between physicians not practicing within the same integrated system, are still needed to improve shared cancer care.

Figure 1

Coordination of primary care physicians and oncologists within Integrated Health Systems using Electronic Health Records: modes of communication, defined responsibilities, and additional roles for PCPs in cancer care.