Improving the Transition From Oncology to Primary Care Teams: A Case for Shared Leadership

2016 ◽  
Vol 12 (11) ◽  
pp. 1012-1019 ◽  
Author(s):  
Dominique Tremblay ◽  
Jean Latreille ◽  
Karine Bilodeau ◽  
Arnaud Samson ◽  
Linda Roy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Shared Leadership ◽  
Primary Care Providers ◽  
Shared Responsibility ◽  
Primary Therapy ◽  
Care Providers ◽  
Curative Intent ◽  
Detailed Case ◽  
Primary Care Teams

This article discusses the case of a 47-year-old woman who underwent primary therapy with curative intent for breast cancer. The case illustrates a number of failure events in transferring information and responsibility from oncology to primary care teams. The article emphasizes the importance of shared leadership, as multiple team members, dispersed in time and space, pursue their own objectives while achieving the common goal of coordinating care for survivors of cancer transitioning across settings. Shared leadership is defined as a team property comprising shared responsibility and mutual influence between the patient and the patient’s family, primary care providers, and oncology teams, whereby they lead each other toward quality and safety of care. Teams, including the patient-family, should achieve leadership when their contribution is relevant in managing task interdependence during transition. Shared leadership fosters coordinated actions to enable functioning as an integrated team-of-teams. This article illustrates how shared leadership can make a difference to coordinate interfaces and pathways, from therapy with curative intent to the follow-up and management of survivors of breast cancer. The detailed case is elaborated as a clinical vignette. It can be used by care providers and researchers to consider the need for new models of care for survivors of cancer by addressing the following questions. Who accepts shared leadership, how, with whom, and under what conditions? What is the evidence that supports the answers to these questions? The detailed case is also valuable for medical and allied health professional education.

scholarly journals Variation in Breast Cancer Screening Recommendations by Primary Care Providers Surveyed in Wisconsin

2020 ◽  
Vol 35 (9) ◽  
pp. 2553-2559
Author(s):  
Emily Nachtigal ◽  
Noelle K. LoConte ◽  
Sarah Kerch ◽  
Xiao Zhang ◽  
Amanda Parkes
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Primary Care Providers ◽  
Care Providers

scholarly journals Transitioning to Breast Cancer Survivorship: Perspectives of Patients, Cancer Specialists, and Primary Care Providers

2009 ◽  
Vol 24 (S2) ◽  
pp. 459-466 ◽  
Author(s):  
Melinda Kantsiper ◽  
Erin L. McDonald ◽  
Gail Geller ◽  
Lillie Shockney ◽  
Claire Snyder ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Survivorship ◽  
Primary Care Providers ◽  
Care Providers ◽  
Breast Cancer Survivorship ◽  
Cancer Specialists

scholarly journals Changes in primary care provider utilization by phase of care for women diagnosed with breast cancer: a CanIMPACT longitudinal cohort study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
K. Decker ◽  
◽  
R. Moineddin ◽  
C. Kendell ◽  
R. Urquhart ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cohort Study ◽  
Cancer Diagnosis ◽  
Primary Care Providers ◽  
Care Providers ◽  
High User ◽  
Factors Associated ◽  
Prevention And Early Detection ◽  
Canadian Provinces

Abstract Background Primary care providers (PCPs) have always played an important role in cancer diagnosis. There is increasing awareness of the importance of their role during treatment and survivorship. We examined changes in PCP utilization from pre-diagnosis to survival for women diagnosed with breast cancer, factors associated with being a high user of primary care, and variation across four Canadian provinces. Methods The cohorts included women 18+ years of age diagnosed with stage I-III invasive breast cancer in years 2007–2012 in British Columbia (BC), Manitoba (MB), Ontario (ON), and Nova Scotia (NS) who had surgery plus adjuvant chemotherapy and were alive 30+ months after diagnosis (N = 19,589). We compared the rate of PCP visits in each province across phases of care (pre-diagnosis, diagnosis, treatment, and survival years 1 to 4). Results PCP use was greatest during treatment and decreased with each successive survival year in all provinces. The unadjusted difference in PCP use between treatment and pre-diagnosis was most pronounced in BC where PCP use was six times higher during treatment than pre-diagnosis. Factors associated with being a high user of primary care during treatment included comorbidity and being a high user of care pre-diagnosis in all provinces. These factors were also associated with being a higher user of care during diagnosis and survival. Conclusions Contrary to the traditional view that PCPs focus primarily on cancer prevention and early detection, we found that PCPs are involved in the care of women diagnosed with breast cancer across all phases of care.

Who is ordering breast MRIs in newly diagnosed breast cancer patients?

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 24-24
Author(s):  
Anya Romanoff ◽  
Matthew McMurray ◽  
Hank Schmidt ◽  
Parissa Tabrizian ◽  
Christina Weltz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Patients ◽  
Breast Mri ◽  
Primary Care Providers ◽  
Newly Diagnosed ◽  
Care Providers ◽  
Breast Cancer Patients ◽  
Breast Center ◽  
Breast Surgeon

24 Background: Utilization of breast MRI has increased dramatically in recent years, and there is ongoing debate regarding the role of MRI in patients with breast cancer. Guidelines for MRI use in newly diagnosed breast cancer patients have not been established; therefore, provider ordering of MRI in this population is variable. We investigated patterns of MRI ordering by healthcare providers in the setting of newly diagnosed breast cancer and analyzed predictors of MRI utilization. Methods: All newly diagnosed breast cancer patients presenting for surgical management at a single tertiary care breast center from January 2011 through December 2013 were reviewed. Cases were evaluated for the use of preoperative MRI, and medical specialty of the ordering provider was determined. Patients who presented to a specialized breast center with MRI already completed were compared to those who had MRIs ordered by their treating breast surgeon. Results: A total of 423 women with newly diagnosed breast cancer underwent MRI during the study period. In this group, 253/423 patients (60%) presented to our institution with an MRI already completed. Of MRIs performed prior to presentation, 73% were ordered by a primary care provider, and 27% were ordered by a breast specialist seen previously. Race was a significant predictor of having an MRI before presentation to a breast center (64% of white patients, 41% of black patients, 25% of Asians, and 65% of Hispanic patients, p < .001). Women with commercial insurance were significantly more likely to have an MRI completed before presentation than those with Medicaid (62% versus 37%, p = .002). Age, family history of breast cancer, genetic testing, breast density, mode of diagnosis, and biopsy pathology were not significant factors in determining whether a patient underwent MRI prior to presentation to a breast surgeon. Conclusions: In our experience, the majority of MRIs performed in newly diagnosed patients with breast cancer were ordered by primary care providers as part of their patient’s initial workup. Patient race and insurance status were significant predictors of having an MRI ordered prior to seeing a breast specialist. Further research is needed to develop guidelines for breast MRI use in newly diagnosed cancer patients.

Impact of primary care providers on patient screening mammography and initial presentation in an underserved clinical setting.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 8-8
Author(s):  
Ajaratu Keshinro ◽  
Ioannis Hatzaras ◽  
Shubhada Dhage ◽  
Kenneth Rifkind ◽  
Kathie-Ann P. Joseph
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Primary Care Providers ◽  
Screening Mammography ◽  
Stage I ◽  
Cancer Stage ◽  
Care Providers ◽  
Palpable Mass ◽  
Stage Iv Breast Cancer ◽  
The Impact

8 Background: Screening mammography (SM) is a routinely used modality for earlier detection of breast cancer and is effective in reducing breast cancer-related morbidity and mortality. A better understanding of the impact of access to primary care physician (PCP), on the screening protocols and stage presentation, is needed to address the issue of breast cancer stage disparity amongst underserved women. Methods: A retrospective chart review of the electronic medical record, for breast cancer patients newly diagnosed from 2012-2013, was performed using the tumor registry at Bellevue Hospital Center, the largest public hospital in New York City. Patients with recurrent breast cancer, stage IV breast cancer, and those that weren’t managed surgically at our institution, were excluded from the study. Data including patient demographics, established relationship with PCP, and screening mammogram and palpable mass at presentation, were obtained and analyzed using SPSS Statistics Software. Results: 173 patients were included in the study of which 5 presented with bilateral breast cancer (n = 178). The majority of the patients seen at our institution were from minority groups, primarily Hispanic (34%) and Chinese (23%). 129 patients (72%) had a PCP at the time of diagnosis versus 49 patients (28%) without a PCP. Patients without a PCP were more likely to have a palpable breast mass at presentation, compared to patients with a PCP (73% vs. 42% respectively, p < 0.05). Furthermore, only 32 % of patients without a PCP had a SM at time of presentation, compared to 61% of patients with a PCP (p = 0.003). Overall, in the group of patients with a PCP, the majority presented with stage I breast cancer (43%), followed by 29% with stage 0. In comparison, the majority of patient without a PCP presented with stage II (41%), followed by 29% with stage I (p = 0.019). Conclusions: There is a benefit for patients with access to a PCP, as it leads to a higher likelihood of breast cancer detection via SM, as opposed to a symptomatic presentation, such as a palpable mass. Therefore, these patients are more likely to be diagnosed with an earlier stage of breast cancer, which improves their mortality.

scholarly journals What do primary care providers think about implementing breast cancer survivorship care?

2018 ◽  
Vol 25 (3) ◽  
pp. 196 ◽  
Author(s):  
M. Luctkar-Flude ◽  
A. Aiken ◽  
M.A. McColl ◽  
J. Tranmer
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Early Stage ◽  
Primary Care Providers ◽  
Evidence Based ◽  
Survivorship Care ◽  
Care Providers ◽  
Structured Interviews ◽  
Educational Preparation ◽  
Care Guidelines

Purpose As cancer centres move forward with earlier discharge of stable survivors of early-stage breast cancer (bca) to primary care follow-up, it is important to address known knowledge and practice gaps among primary care providers (pcps). In the present qualitative descriptive study, we examined the practice context that influences implementation of existing clinical practice guidelines for providing such care. The purpose was to determine the challenges, strengths, and opportunities related to implementing comprehensive evidence-based bca survivorship care guidelines by pcps in southeastern Ontario.Methods Semi-structured interviews were conducted with 19 pcps: 10 physicians and 9 nurse practitioners.Results Thematic analysis revealed 6 themes within the broad categories of knowledge, attitudes, and resources. Participants highlighted 3 major challenges related to providing bca survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden. They also described 3 major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles.Conclusions We identified several important challenges to implementation of comprehensive evidence-based survivorship care for bca survivors, as well as several strengths and opportunities that could be built upon to address those challenges. Findings from our research could inform targeted knowledge translation interventions to provide support and education for pcps and bca survivors.

Sign in / Sign up

Export Citation Format

Share Document