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SUMMARY
This study used focus groups and inductive qualitative analysis of transcripts to determine rural primary care providers’ (PCP) perceptions of cancer care for women patients in their practice, and to learn more about their perceived role in the cancer care continuum. Three overarching themes were discovered. (1) PCPs perceive that women are willing to act on their suggestions because of the PCP’s ability to establish genuine human-to-human connections (“knowing the patients”) and the patient’s belief in their medical expertise. (2) Patients often seek their PCP’s opinion to “walk through treatment” before acting upon a specialist's prescription of treatment. (3) PCPs report a sense of "losing the patient to the system" because of a lack of clarity about communication responsibilities with specialists around sensitive diagnostic information. The report also noted three general patient financial burdens perceived by PCPs that influence clinical discontinuities for their patients with breast cancer: missing work for appointments, travel expenses, and price of drugs not covered by insurance. Finally, the PCP's noted that their uninsured patients fared far better in terms of treatment than those who were underinsured.
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FINDINGS
10.1 Primary care providers describe set of barriers that contribute to the discontinuities experienced by some of their patients with breast cancer. These include: (a) financial barriers, due to rural women often having to schedule screening or treatment during the week, necessitating they miss a day of work; (b) expense of travel to referral centers; (c) financial burden of certain treatments or drugs not fully covered by insurance.
10.2 Overall, the primary care providers noted that their uninsured patients fared far better in terms of treatment than those who were underinsured.
10.3 Women responded to their primary care provider suggestions because of a human-to-human caring connection; not because they were medical experts (though they clearly felt the women viewed them in this way, and depended on their expert knowledge).
10.4 Primary care providers described that patients commonly came to them after a visit to the specialist or oncologist at the cancer center, to elicit their opinion on recommended treatments and therapies before initiating the prescribed treatment.
10.5 Patients brought current treatment information to them, as patients and providers alike had access to a great deal of electronic information. Some primary care providers reported a desire to keep up with their patients’ knowledge about treatment, or tried to help them sort out which information to pay attention to.
10.6 Sometimes PCPs were unclear about who (specialist or primary care provider) would give information to the patient regarding her diagnosis.
10.7 Primary care providers described their patient’s experiences with some specialist care as being much segmented.
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