Patient experiences of GP-led colon cancer survivorship care: a Dutch mixed-methods evaluation.

BACKGROUND: Colon cancer survivorship care constitutes both follow-up and aftercare. GP involvement may help to personalise care. AIM: To explore patients' experiences of GP-led versus surgeon-led survivorship care. DESIGN AND SETTING: Patients with stage I to III colon cancer were recruited from eight Dutch hospitals and randomised to receive care by either the GP or surgeon. METHOD: A mixed-methods approach was used to compare GP-led care with surgeon-led care. After 1 year the Consumer Quality Index (CQI) was used to measure quality aspects of care. Next, interviews were performed at various time points (3-6 years after surgery) to explore patients' experiences in depth. RESULTS: A total of 261 questionnaires were returned by patients and 25 semi-structured interviews were included in the study. Overall, patients were satisfied with both GP-led and surgeon-led care (ratings 9.6 [standard deviation {SD} 1.1] versus 9.4 [SD 1.1] out of 10). No important differences were seen in quality of care as measured by CQI. Interviews revealed that patients often had little expectation of care from either healthcare professional. They described follow-up consultations as short, medically oriented, and centred around discussing follow-up test results. Patients also reported few symptoms. Care for patients in the GP-led group was organised in different ways, ranging from solely on patient's initiative to shared care. Patients sometimes desired a more guiding role from their GP, whereas others preferred to be proactive themselves. CONCLUSION: Patients experienced a high quality of colon cancer survivorship care from both GPs and surgeons. If the GP is going to be more involved, patients require a clear understanding of roles and responsibilities.

Experiences with screening for atrial fibrillation: a qualitative study in general practice.

BACKGROUND: Guidelines recommend screening for atrial fibrillation (AF). Currently, screening is not considered standard care among GPs. AIM: To explore the experiences of primary care workers with different methods of screening for AF and with implementation in daily practice. DESIGN & SETTING: A qualitative study using semi-structured interviews with GPs, nurses, and healthcare assistants (HCAs) who were experienced with implementing different methods of screening. METHOD: Two independent researchers audio-recorded and analysed interviews using a thematic approach. They asked participants about their experiences with the different methods used for screening AF and which obstacles they faced when implementing screening in daily practice. RESULTS: In total 15 GPs, nurse practitioners, and HCAs from seven different practices were interviewed. The GP's office is suited for screening for AF, which ideally should be integrated with standard care. Participants considered pulse palpation, automated sphygmomanometer with AF detection, and single-lead electrocardiography (ECG) as practical tests. Participants trusted pulse palpation over the algorithm of the devices. The follow-up of a positive test with a time-consuming 12-lead ECG hindered integration of screening. The single-lead ECG device reduced the need for immediate follow-up because it can record a rhythm strip. The extra workload of screening and lack of financial coverage form obstacles for implementation. CONCLUSION: Pulse palpation, automated blood pressure measure monitors with AF detection, and single-lead ECGs might facilitate screening in a general practice setting. When implementing screening, focus should be on how to avoid disruption of consultation hours by unplanned 12-lead ECGs.