June 2002 • Volume 8 • Number 6 |
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• Cancer & the FP •
Would it surprise you to learn that, when it comes to deciding between cancer treatment options, some of your patients may very well value your opinion over that of their surgeon or their oncologist?
That's precisely the case, according to initial results of a small qualitative study presented during the 2002 convocation of practices conducting practice-based research, held here this spring.
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The study's purpose was to provide an initial feel for the role family physicians play in the care of their patients with cancer, said John Hickner, M.D., director of AAFP's National Network for Family Practice and Primary Care Research and principal investigator for the study. "There's been virtually nothing written about how family physicians are involved in the care of their patients once they're diagnosed with cancer, yet we know many family physicians are heavily involved in that care."
In designing the study, researchers made a concerted attempt to ensure variability in both physician and patient demographics and other characteristics. Physician participants were chosen from different geographic areas and practice settings, with some practicing in large academic centers and some in smaller clinical settings.
One particularly intriguing finding was the respect cancer patients accord their family physicians: "Some patients come into your office, and even though they've been to Mecca and heard the expert opinion, they still want to know what you think," said Hickner. "They'll say, 'Well, I've been to Mayo, and they say I ought to do this, but I wasn't sure. I wanted to come back and talk to you about it first.'"
Phyllis Naragon, AAFP organizational research marketing manager and co-presenter of the session, gave a brief overview of other study findings:
Responses from the patients interviewed reflected similar themes:
FPs at the convocation shared some of their experiences with cancer patients. Michael Hartsell, M.D., of Greeneville, Tenn., negotiates with the patient the extent to which he or she wants Hartsell to remain involved. The key, he said, is to help patients feel they're in control of their treatment.
He described an experience with one of his patients -- a woman with ovarian cancer who'd been through two harrowing chemotherapy rounds, was suffering serious side effects and was ready to throw in the towel. "I told her, 'Do me a favor -- tell them what a difficult time you're having,' and the next time I saw her, she was absolutely radiant," said Hartsell. "She was still engaged in the process and was very much empowered. So, not only do we help them with advice but we also help keep them engaged."
Yet, it can be difficult to maintain that connection with patients, said Andrew Eisenberg, M.D., of Madisonville, Texas. He's concerned about patients in his practice who are treated at facilities from 30 to 90 miles away. "The problem is that with the place that's 90 miles away, I don't get any reports whatsoever," Eisenberg said. "That's very frustrating because the rest of the family may be in my community. They'll come in and ask, 'Well, what's going on?' and you just don't know.
"There are some patients who go to cancer centers, and they just get lost. My personal feeling is that they don't get the best care in that situation because the care gets fragmented."
Donya Powers, M.D., of East Providence, R.I., agreed with Eisenberg's assessment. "There are too many people between me and the person who's providing the treatment," she said. A lack of ready access to medical records and test results can be a significant drawback when providing ongoing care. "You worry about these patients being in limbo when they should have a very structured follow-up, something that's been written out for them," said Powers.
In the end, said Hartsell, the level of physician involvement is up to the patient -- for better or for worse. "I have a number of folks in my practice with prostate cancer whom we might potentially be following for years and years, and it's their comorbidities that'll eventually get to them," he said. "Yet they still get so paranoid, thinking, 'I have cancer,' even in the face of cardiomyopathy or advanced COPD. It's that diagnosis -- that word -- and where it drives them that determines how we participate in their care."
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.
