Supportive Care in Cancer

, Volume 20, Issue 12, pp 3071–3078 | Cite as

A qualitative exploration of the role of primary care in supporting colorectal cancer patients

  • Susan Hall
  • Nicola Gray
  • Susan Browne
  • Sue Ziebland
  • Neil C. Campbell
Original Article



To explore experiences and support needs of people with colorectal cancer, with a focus on identifying opportunities for primary care interventions.


We conducted a new qualitative analysis of an existing dataset, comprising semi-structured interview transcripts from 39 people with colorectal cancer from across the UK, interviewed in 2001–2002 for Then, we conducted semi-structured interviews with 30 people with colorectal cancer from North East Scotland and Glasgow in 2009 and analysed these new data to explore themes and challenge hypotheses that emerged from the Healthtalkonline data.


Formal sources of support, including that from primary care, were valued by those who received them, but provision was described as sporadic both in 2002 and in 2009. However, more of the 2009 participants gave descriptions of specialist nurse and community nurse involvement, and telephone contact from general practitioners, which were welcomed. Improvements in meeting information needs, particularly on the issues of diet and sex, were identified by 2009. A recurring issue reported by patients was the distress experienced by their own friends and family; some patients found themselves having to provide, rather than receive, emotional support at this difficult time.


There have been improvements in support for people with colorectal cancer since 2002, with more specialist and community nurse involvement, and telephone contact from general practitioners, but provision remains piecemeal. Patients would benefit if their families received support, and primary care may be in a good position to provide this. A proactive approach from general practitioners in the post-discharge period is valued.


Cancer Family Medicine Qualitative research Social care 


  1. 1.
    Maddams J, Brewster D, Gavin A, Steward J, Elliott J, Utley M, Møller H (2009) Cancer prevalence in the United Kingdom: estimates for 2008. Br J Cancer 101:541–547. doi:10.1038/sj.bjc.6605148 PubMedCrossRefGoogle Scholar
  2. 2.
  3. 3.
  4. 4.
    Helgeson VS, Cohen S (1996) Social support and adjustment to cancer: reconciling descriptive, correlational, and intervention research. Health Psychol 15:135–148. doi:10.1037/0278-6133.15.2.135# PubMedCrossRefGoogle Scholar
  5. 5.
    Schroevers MJ, Helgeson VS, Sanderman R, Ranchor AV (2010) Type of social support matters for prediction of posttraumatic growth among cancer survivors. Psych Oncol 19:46–53. doi:10.1002/pon.1501 CrossRefGoogle Scholar
  6. 6.
    Berkman LF, Syme L (1979) Social networks, host resistance, and mortality: a nine- year follow-up study of Alemeda County residents. Am J Epidemiol 109:186–204PubMedGoogle Scholar
  7. 7.
    House JS, Landis KR, Umberson D (1988) Social relationships and health. Science 241:540–545. doi:10.1126/science.3399889 PubMedCrossRefGoogle Scholar
  8. 8.
    Ringdal GI, Ringdal K, Jordhoy MS, Kaasa S (2007) Does social support from family and friends work as a buffer against reactions to stressful life events such as terminal cancer? Palliat Support Care 5:61–69. doi:10.1017/S1478951507070083 PubMedCrossRefGoogle Scholar
  9. 9.
    Harrison SE, Watson EK, Ward AM, Khan NF, Turner D, Adams E, Forman D, Roche MF, Rose PW (2011) Primary health and supportive care needs of long-term cancer survivors: a questionnaire survey. J Clin Oncol 29:2091–2098. doi:10.1200/JCO.2010.32.5167 PubMedCrossRefGoogle Scholar
  10. 10.
    Armes J, Crowe M, Colbourne L, Morgan H, Murrells T, Oakley C, Palmer N, Ream E, Young A, Richardson A (2009) Patients’ supportive care needs beyond the end of cancer treatment: a prospective, longitudinal survey. J Clin Oncol 27:6172–6179. doi:10.1200/JCO.2009.22.5151 PubMedCrossRefGoogle Scholar
  11. 11.
    Sapp AL, Trentham-Deitz A, Newcomb PA, Hampton J, Mionpour CM, Remington PL (2003) Social networks and quality of life among female long-term colorectal cancer survivors. Cancer 98:1749–1758. doi:10.1002/cncr.11717 PubMedCrossRefGoogle Scholar
  12. 12.
    Woods LM, Rachet B, Coleman MP (2006) Origins of socio-economic inequalities in cancer survival: a review. Ann Oncol 17:5–19. doi:10.1093/annonc/mdj007 PubMedCrossRefGoogle Scholar
  13. 13.
    NHS Modernisation Agency, Macmillan Cancer Relief, National Cancer Action Team (2004) Cancer in primary care: a guide to good practice. Department of Health, LondonGoogle Scholar
  14. 14.
    Khan NF, Evans J, Rose PW (2011) A qualitative study of unmet needs and interactions with primary care among cancer survivors. Br J Cancer 105(Suppl 1):S46–S51. doi:10.1038/bjc.2011.422 PubMedCrossRefGoogle Scholar
  15. 15.
    Herxheimer A, McPherson A, Miller R, Shepperd S, Yaphe J, Ziebland S (2000) A database of patients’ experiences (Healthtalkonline): new ways of sharing experiences and information using a multi-media approach. Lancet 355:1540–1543. doi:10.1016/S0140-6736(00)02174-7 PubMedCrossRefGoogle Scholar
  16. 16.
    Rozmovits L, Ziebland S (2004) Expressions of loss of adulthood in the narratives of people with colorectal cancer. Qual Health Res 14:187–203. doi:10.1177/1049732303260874 PubMedCrossRefGoogle Scholar
  17. 17.
    Rozmovits L, Rose P, Ziebland S (2004) In the absence of evidence, who chooses? A qualitative study of patients’ needs after treatment for colorectal cancer. J Health Serv Res Policy 9:159–164. doi:10.1258/1355819041403231 PubMedCrossRefGoogle Scholar
  18. 18.
    Emslie C, Browne S, MacLeod U, Rozmovits ME, Ziebland S (2009) “Getting through” not “going under”: a qualitative study of gender and spousal support after diagnosis with colorectal cancer. Soc Sci Med 68:1169–1175. doi:10.1016/j.socscimed.2009.01.004 PubMedCrossRefGoogle Scholar
  19. 19.
  20. 20.
    Shekelle P (2003) New contract for general practitioners. BMJ 326:457–458. doi:10.1136/bmj.326.7387.457 PubMedCrossRefGoogle Scholar
  21. 21.
    NHS Scotland (2004) Nursing people with cancer in Scotland. Scottish Executive, Edinburgh.
  22. 22.
    ISD Scotland (2010) Nursing and Midwifery Workforce. Clinical nurse specialists. Accessed 4 October 2011
  23. 23.
    Scottish Government (2011) Emergency inpatients average length of stay. Accessed 4 October 2011
  24. 24.
  25. 25.
    Hewitt H, Gafaranga J, McKinstry B (2010) Comparison of face-to-face and telephone consultations in primary care: qualitative analysis. Br J Gen Pract 60:201–212. doi:10.3399/bjgp10X501831 CrossRefGoogle Scholar
  26. 26.
    McKenzie H, Boughton M, Hayes L, Forsyth S, Davies M, Underwood E, McVey P (2007) A sense of security for cancer patients at home: the role of community nurses. Health Soc Care Community 15:352–359. doi:10.1111/j.1365-2524.2007.00694.x PubMedCrossRefGoogle Scholar
  27. 27.
    Wilson K, Pateman B, Beaver K, Luker KA (2002) Patient and carer needs following a cancer-related hospital admission: the importance of referral to the district nursing service. J Adv Nurs 38:245–253. doi:10.1046/j.1365-2648.2002.02173.x PubMedCrossRefGoogle Scholar
  28. 28.
    Harding R, Higginson IJ (2003) What is the best way to help caregivers in cancer and palliative care? A systematic literature review of interventions and their effectiveness. Palliat Med 17:63–74. doi:10.1191/0269216303pm667oa PubMedCrossRefGoogle Scholar
  29. 29.
    Cain R, Maclean M, Sellick S (2004) Giving support and getting help: informal caregivers’ experiences with palliative care services. Palliat Support Care 2:265–272. doi:10.1017/S1478951504040350 PubMedCrossRefGoogle Scholar
  30. 30.
    Vivar CG, Canga N, Canga AD, Arantzamendi M (2009) The psychosocial impact of recurrence on cancer survivors and family members: a narrative review. J Adv Nurs 65:724–736. doi:10.1111/j.1365-2648.2008.04939.x PubMedCrossRefGoogle Scholar
  31. 31.
    Mellon S, Northouse LL, Weiss LK (2006) A population based study of the quality of life of cancer survivors and their family caregivers. Cancer Nurs 29:120–131. doi:10.1097/00002820-200603000-00007 PubMedCrossRefGoogle Scholar
  32. 32.
    Schultz U, Schwarzer R (2004) Long-term effects of spousal support on coping with cancer after surgery. J Soc Clin Psychol 23:716–732. doi:10.1521/jscp.23.5.716.50746 CrossRefGoogle Scholar
  33. 33.
    Heaton J (2004) Reworking qualitative data. Sage Publications, LondonGoogle Scholar
  34. 34.
    Hammersley M (2010) Can we re-use qualitative data via secondary analysis? Notes on some terminological and substantive issues. Sociol Res Online. doi:10.5153/sro.2076
  35. 35.
    Aabom B, Pfeiffer P (2009) Why are some patients in treatment for advanced cancer reluctant to consult their GP? Scand J Prim Health Care 27:58–62. doi:10.1080/02813430802677817 PubMedCrossRefGoogle Scholar
  36. 36.
    Mao JJ, Bowman MA, Stricker CT, DeMichele A, Jacobs L, Chan D, Armstrong K (2009) Delivery of survivorship care by primary care physicians: the perspective of breast cancer patients. J Clin Oncol 27:933–938. doi:10.1200/JCO.2008.18.0679xxx PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Susan Hall
    • 1
  • Nicola Gray
    • 1
  • Susan Browne
    • 2
  • Sue Ziebland
    • 3
  • Neil C. Campbell
    • 1
  1. 1.Academic Primary CareUniversity of AberdeenAberdeenUK
  2. 2.General Practice and Primary CareUniversity of GlasgowGlasgowUK
  3. 3.Department of Primary Health CareUniversity of OxfordOxfordUK

Personalised recommendations