Involvement of Primary Care Providers in Cancer Treatment Decisions
The idea of team-based cancer care most often focuses on involving primary care physicians in the care of cancer survivors, but research has shown patients are also discussing initial cancer treatment options with their primary care doctors. Now, a new study by Wallner et al in Cancer has found that a significant number of these primary care physicians report notable gaps in their knowledge of cancer treatment options.
“Primary care physicians may be involved in cancer care earlier than we thought. If we are going to promote their involvement, we may need to start doing that earlier, around the time of initial treatment, and ensure primary care physicians have the information they need to effectively participate in the decision-making process,” said Lauren P. Wallner, PhD, MPH, a health services researcher at the University of Michigan Rogel Cancer Center.
Dr. Wallner and colleagues from the Cancer Surveillance and Outcomes Research Team surveyed 517 primary care physicians who were linked to 1,077 women treated for early-stage breast cancer. Physicians were asked whether they had discussed surgery, radiation, or chemotherapy options with their patients. They were also asked how comfortable they were discussing these issues and whether they had the knowledge to help with treatment decisions.
Survey Findings
Researchers found that 34% of primary care physicians had discussed surgery options with their patients, 23% had discussed radiation, and 22% had discussed chemotherapy. Physicians who reported more comfort with cancer treatment discussions were more likely to have these discussions. However, among physicians who reported involvement in surgery decisions, 22% said they were not comfortable having that discussion and 17% said they did have the necessary knowledge. Similar results were found for primary care physicians who had discussed options for radiation and chemotherapy.
“We found that among those involved, some primary care physicians felt they did not have the knowledge necessary to participate in these treatment decisions. If they’re going to be involved, we need to find a way to make sure they have the knowledge to do so, and we support them in a way that ensures they’re confident and able to do so,” said Dr. Wallner, who is Assistant Professor of General Medicine and Epidemiology at the University of Michigan.
Study Limitations
The study did not address what patients discussed or how detailed those discussions were. As such, Dr. Wallner emphasized that the nature of these conversations and how they influence treatment choices is not yet clear, but, she says, helping patients better understand the risks and benefits of treatment options is a good thing. For patients who have a long-standing relationship with their primary care doctor, their physician may have a good grasp of the patient’s values and preferences and may be able to help the patient navigate these decisions.
“This is an emerging challenge for primary care providers,” Dr. Wallner explained. “Inundating them with detailed information about all possible cancer treatments is not feasible. But these providers are likely to start becoming even more involved with the more prevalent cancers, such as breast or prostate cancer. They need to have sufficient resources and support to be prepared for these conversations.”
Disclosure: The study authors' full disclosures can be found at onlinelibrary.wiley.com.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
