ABSTRACT
BACKGROUND: Family physicians (fps) play a role in aspects of personalized medicine in cancer, including assessment of increased risk because of family history. Little is known about the potential role of fps in supporting cancer patients who undergo tumour gene expression profile (gep) testing. METHODS: We conducted a mixed-methods study with qualitative and quantitative components. Qualitative data from focus groups and interviews with fps and cancer specialists about the role of fps in breast cancer gep testing were obtained during studies conducted within the pan-Canadian canimpact research program. We determined the number of visits by breast cancer patients to a fp between the first medical oncology visit and the start of chemotherapy, a period when patients might be considering results of gep testing. RESULTS: The fps and cancer specialists felt that ordering gep tests and explaining the results was the role of the oncologist. A new fp role was identified relating to the fp-patient relationship: supporting patients in making adjuvant therapy decisions informed by gep tests by considering the patient's comorbid conditions, social situation, and preferences. Lack of fp knowledge and resources, and challenges in fp-oncologist communication were seen as significant barriers to that role. Between 28% and 38% of patients visited a fp between the first oncology visit and the start of chemotherapy. CONCLUSIONS: Our findings suggest an emerging role for fps in supporting patients who are making adjuvant treatment decisions after receiving the results of gep testing. For success in this new role, education and point-of-care tools, together with more effective communication strategies between fps and oncologists, are needed.
ABSTRACT
Bereavement is a stressful event for men, yet there are few studies that help explain the important psychological and social factors that may interfere with or facilitate the grieving process in men. The purpose of this study is to describe some of these factors in new widowers and to compare them with those in married men. A community sample of 113 widowers bereaved less than 12 months and a family practice clinic sample of 111 married men matched for age were compared on five psychological and social measures (General Health Questionnaire, Beck Depression Inventory, State-Anxiety Inventory, Social Adjustment Scale, and Social Support Questionnaire). The results indicate significantly more distress in the widowers than in the married men. Highly distressed widowers had more problems with work outside the home, housework, and spare time, and they were younger and less satisfied with their social support than less distressed widowers. Widowers younger than 65 years were significantly more depressed and anxious, and had more social adjustment problems than widowers older than 65. These findings may be useful for longitudinal or intervention studies of widowers and may be of value for primary health care providers.
