Keywords: breast cancer, follow-up care, qualitative methods, continuity of care, general practice

Background:

Breast cancer is the most common cancer among women in Germany. Structured follow-up care can help timely detect recurrences, manage treatment side effects, and improve quality of life. While gynecologists are traditionally responsible for coordinating, general practitioners (GPs) may be particularly well positioned to contribute due to their longitudinal patient relationships and continuity of care. However, their role in breast cancer follow-up care in Germany remains ill-defined.

Research questions:

What are perspectives of breast cancer patients and physicians on GP´s role in breast cancer follow-up care in Germany?

Method:

This study is part of the multiphase mixed-methods BRUNA+ project. Expert workshops with GPs and Gyns (N=9) followed the “deliberative consultations” method. Two discipline-specific and one mixed session were held. Results from six interviews and two focus groups with breast cancer patients (N=17) were presented. Physicians were asked to reach working agreements on: supporting patients in overcoming follow-up barriers, better integrating GPs into follow-up, and improving information exchange between disciplines. All sessions were audio-recorded and analyzed inductively and deductively using thematic analysis (Braun & Clarke, 2006).

Results:

Participants agreed that GPs should encourage patients to attend follow-up, serve as the first contact for therapy side effects, and provide psychosomatic support, but not take a more active role in follow-up care. Sending the hospital’s final report to GPs and improving access to shared patients records (e.g., electronic records (ePA)) would support involvement of GPs. A website with detailed information on therapy side effects could help GPs identify treatment-related symptoms. Opinions diverged on whether GPs should monitor medication-related side effects as part of routine laboratory tests, as this is not covered by statutory insurance in Germany.

Conclusions:

In Germany, GPs involvement into breast cancer follow-up care is limited. Improved digital communication through the new ePA and better information exchange could strengthen GP involvement and continuity of care.

Points for discussion:

How could greater involvement of general practitioners throughout the follow-up process strengthen continuity of care for patients?

What are ways to make general practitioners’ involvement in breast cancer follow-up care more effective?