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Follow-up Care Delivery Among Colorectal Cancer Survivors Most Often Seen by Primary and Subspecialty Care Physicians

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Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

The Institute of Medicine has identified patients as a key source of information for assessing the quality of care.

Objective

To evaluate the association of physician specialty with the content and quality of follow-up cancer care.

Design and Participants

Three hundred three colorectal cancer (CRC) survivors in Northern California were surveyed 2–5 years post-diagnosis.

Measurements

Specialty of physician seen most often [primary care physician (PCP), oncologist, surgeon, or gastroenterologist]; other physician specialties seen; patient characteristics; content of visits; patient-centered quality of follow-up care (communication, coordination, nursing, and staff interactions).

Main Results

A minority (16%) of CRC survivors reported that the doctor they most often saw for follow-up cancer care was a PCP, while 60% saw an oncologist. Many CRC survivors (40%) saw >1 physician for follow-up cancer care. Survivors most often seen by PCPs were more likely to have three or more medical comorbidities (70% vs. 51%, p = 0.012) than survivors seen by subspecialty physicians. Survivors seen by PCPs were less likely to report seeing a doctor for medical tests and more likely to report discussing disease prevention (82% vs. 64%, p = 0.012) or diet (70% vs. 48%, p = 0.005) with their doctor. There were no significant specialty differences in patient-centered quality of follow-up cancer care.

Conclusions

Cancer survivors’ assessment of the quality of care was similar across specialties, while the content of follow-up cancer care varied by physician specialty. These findings provide important information about the potential value of primary care and the need for coordination when delivering care to CRC survivors.

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Acknowledgments

Dr. Haggstrom is supported by VA HSR&D Career Development Award CD207016-2. This research was funded by NCI contract N01-PC-35136 at the NCCC. Preliminary results of the paper were presented at the American Society of Clinical Oncology Annual Meeting, May 2008. This work represents the opinion of the authors and cannot be construed to represent the opinion of the National Cancer Institute, the Department of Veterans Affairs, or the Federal Government.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. VA Health Services Research & Development (HSR&D) Center on Implementing Evidence-based Practice (CIEBP), Richard L. Roudebush VA Medical Center, 1481 West 10th St. (11H), Indianapolis, IN, 46202, USA

    David A. Haggstrom MD, MAS

  2. IU Center for Health Services and Outcomes Research (CHSOR), Regenstrief Institute, Inc., Indianapolis, IN, USA

    David A. Haggstrom MD, MAS

  3. Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA

    David A. Haggstrom MD, MAS

  4. Indiana University Simon Cancer Center, Indianapolis, IN, USA

    David A. Haggstrom MD, MAS & Paul Helft MD

  5. Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

    Neeraj K. Arora PhD

  6. Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Paul Helft MD

  7. The Charles Warren Fairbanks Center for Medical Ethics, Clarian Health, Inc., Indianapolis, IN, USA

    Paul Helft MD

  8. The Indiana University Center for Bioethics, Indiana University, Indianapolis, IN, USA

    Paul Helft MD

  9. Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Marla L. Clayman PhD

  10. Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA

    Marla L. Clayman PhD

  11. Northern California Cancer Center, Fremont, CA, USA

    Ingrid Oakley-Girvan PhD

Authors
  1. David A. Haggstrom MD, MAS
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  2. Neeraj K. Arora PhD
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  3. Paul Helft MD
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  4. Marla L. Clayman PhD
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  5. Ingrid Oakley-Girvan PhD
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Corresponding author

Correspondence to David A. Haggstrom MD, MAS.

Appendix 1

Appendix 1

Physician Communication

  1. 1.

    In the last 12 months, how often did your follow-up care doctor listen carefully to you? (Never, Sometimes, Usually, Always)

  2. 2.

    In the last 12 months, how often did your follow-up care doctor explain things in a way you could understand? (Never, Sometimes, Usually, Always)

  3. 3.

    In the last 12 months, how often did your follow-up care doctor show respect for what you had to say? (Never, Sometimes, Usually, Always)

  4. 4.

    In the last 12 months, how often did your follow-up care doctor encourage you to ask all the cancer-related questions you had? (Never, Sometimes, Usually, Always)

  5. 5.

    In the last 12 months, how often did your follow-up care doctor answer your cancer-related questions to your satisfaction? (Never, Sometimes, Usually, Always)

  6. 6.

    In the last 12 months, how often did your follow-up care doctor make sure that you understood all the information he or she gave you? (Never, Sometimes, Usually, Always)

  7. 7.

    In the last 12 months, how often did your follow-up care doctor spend enough time with you? (Never, Sometimes, Usually, Always)

  8. 8.

    In the last 12 months, how often did you feel rushed by your follow-up care doctor?

  9. 9.

    In the last 12 months, how often did your follow-up care doctor give you as much cancer-related information as you wanted? (Never, Sometimes, Usually, Always)

  10. 10.

    In the last 12 months, how often did you leave your follow-up care doctor’s office or clinic with unanswered questions related to your cancer? (Never, Sometimes, Usually, Always)

Care Coordination

  1. 1.

    In the last 12 months, how often did your follow-up care doctor seem informed and up-to-date about the care you received from any other doctors or health professionals you saw for cancer-related issues or problems? (Never, Sometimes, Usually, Always)

  2. 2.

    In the last 12 months, in your opinion, how often did your follow-up care doctor, the nurses, and other staff at your follow-up care doctor’s office or clinic seem to work well together as a team? (Never, Sometimes, Usually, Always)

Nursing Care

  1. 1.

    In the last 12 months, how often did nurses at your follow-up care doctor’s office or clinic treat you with courtesy and respect? (Never, Sometimes, Usually, Always)

  2. 2.

    In the last 12 months, how often were the nurses at your follow-up care doctor’s office or clinic as helpful as you thought they should be? (Never, Sometimes, Usually, Always)

Interactions with Office Staff

  1. 1.

    In the last 12 months, how often did office staff (such as receptionists and other personnel at the front office) at your follow-up care doctor’s office or clinic treat you with courtesy and respect? (Never, Sometimes, Usually, Always)

  2. 2.

    In the last 12 months, how often was office staff (such as receptionists and other personnel at the front office) at your follow-up care doctor’s office or clinic as helpful as you thought they should be? (Never, Sometimes, Usually, Always)

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Haggstrom, D.A., Arora, N.K., Helft, P. et al. Follow-up Care Delivery Among Colorectal Cancer Survivors Most Often Seen by Primary and Subspecialty Care Physicians. J GEN INTERN MED 24 (Suppl 2), 472–479 (2009). https://doi.org/10.1007/s11606-009-1017-6

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  • DOI: https://doi.org/10.1007/s11606-009-1017-6

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