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. 2019 Apr 14;9(4):e026383. doi: 10.1136/bmjopen-2018-026383

Table 2.

Study results for interventions aiming at active involvement of the GP during curative intent

Reference,
Country		 Primary and secondary outcome measures
(instrument used),
Timing of measurement		 Findings if applicable to study:
1. Uptake of intervention
2. Healthcare use
3. Patient-related outcomes
4. GP-related outcomes
Drury et al 25 Primary

  • Healthcare use (patient reported).

  • Patient satisfaction with communication and participation in care (SDQ).

  • Quality of life (EORTC QLQ-C30).

Secondary

  • GP views on PHR (SDQ).

Measurements
Single measurement at 3 months		 Uptake of intervention 27.3% of 202 responding GPs had seen the PHR
Healthcare use (intervention vs. control)

  • Contact with care providers in 3 months follow-up;

    • Visit GP 78% vs 85%.

    • Visited secondary care clinics 95% vs 95%.

Patient-related outcomes (intervention vs control)

  • Satisfaction communication and participation in care mean±SD (scale 1–5): 3.83±0.59 vs 3.80±0.59, (95% CI 0.09 to 0.15)

  • Confidence in facing future aspects of cancer: 62% vs 71%, p=0.05.

  • Quality of life mean global scores: 66.8±24.2 vs 65.3±23.7.

GP-related outcome (seen PHR vs not seen PHR)

  • GP agrees that patients should have full access to their records 57% vs 57%.
Bergholdt et al
Hansen et al 20 		Primary
Quality of life (EORTC QLQ-C30)
Secondary

  • Psychological distress (POMS)

  • Symptoms (scale of the EORTC QLQ-C30)

  • Patient satisfaction with: their GP on five dimensions (Dan-PEP), support during the cancer course (one ad hoc question, likert scale, at 14 months)

  • GP proactivity measured on GP and patient level. (one ad hoc question, at 14 months)

  • GP’s satisfaction with their contribution to the patient’s rehabilitation course (two ad hoc questions, likert scale, at 14 months)

Measurements
At 6 and 14 months		 Uptake of intervention proactivity of GP intervention vs control: GP reported 61.2% vs 55.2% p=0.10, patient reported 60.1% vs 51.9% p=0.15.
Patient-related outcomes (intervention vs control)

  • Quality of life; mean difference (95% CI);

    • at 6 months 1.25 (−2.4–4.9)

    • at 14 months −0.71 (−4.3–2.8)

  • Psychological distress, mean difference (95% CI); −0.68 (−4.3–3.0)

  • Patient participation on rehabilitation services, OR adj (95% CI); 1.0 (0.7–1.5)

  • Patient satisfaction with:

    • GP on five dimensions, OR adj (95% CI) All NS; doctor–patient relationship 0.94 (0.35–2.47), medical care 1.2 (0.5–3.0), information and support 1.6 (0.6–4.1), organisation of care 1.3 (0.8–2.1), GP’s accessibility 1.2 (0.6–2.3).

    • GP support during the cancer course, OR adj (95% CI); 1.14 (0.7–1.8).

  • Proactivity GP and rehabilitation activity patient, OR adj (95% CI); 1.96 (1.2–3.3).

GP-related outcomes (intervention vs control)

  • Overall satisfaction, OR adj (95% CI); 1.10 (0.47–2.56)
Johansson et al 23 Primary
Healthcare use:

  • Hospital admissions and days of hospitalisation (with correction for weight loss and distress) (record reviewing)

  • Utilisation of outpatient care (record reviewing)

Measurements
Single measurement at 3 months		 Uptake of intervention Not reported
Healthcare use (intervention vs. control)

  • Subgroup analysis for age (year) hospital admissions mean number of admissions ±SD, 3 months follow-up;

    • ≥70y: 0.4±0.6 vs 0.9±1.0 (Student t-test p=0.0002).

    • <70y: 1.0±1.0 vs 0.9±0.8 (Student t-test p=0.38).

  • Days of hospitalisation;

    • ≥70y: 3.8±8.8 vs 8.9±18.8 (Tukey HSD, p<0.01).

    • <70y: 4.4±5.9 vs 3.6±4.9 (Student t-test p=0.24).

  • Mean number of outpatient care visits per patient;

    • ≥70y: 6.8±8.8 vs 6.0±7.0 (Student t-test p=0.53).

    • <70y: 13.4±11.2 vs .12.9±11.5 (Student t-test p=0.7257).

  • Acute visits;

    • ≥70y: in 5% vs 15% of patients (χ² p=0.034).

    • <70y: in 11% vs 10% of patients (χ² p=0.80).
Johnson et al 26 Primary

  • Depression (HADS)

  • Anxiety (HADS)

  • Coping (Mini-MAC)

  • Empowerment (PES)

Secondary

  • Healthcare use; hospital admission and emergency presentation (record viewing), number of GP visits (unknown).

  • Patient perception of care (SDQ).

  • GP perception of care (SDQ).

Measurements

  • before treatment

  • midway through treatment

  • after treatment

 Uptake of intervention Not reported
Healthcare use (intervention vs. control)

  • Emergency department presentations: no significant between-group differences were observed.

  • Average number of GP visits 2.79 vs 1.61, p<0.001.

Patient-related outcomes (intervention vs control)

  • Patient perception of care;

    • GP could help in ways specialist could not: 57% vs 19% (χ²=11.5; p=0.002).

    • Patient opinion concerning PHR/GP visit after CT course:

      • 81% considered PHR useful

      • 35% considered visit inconvenient

  • Depression; geometric mean score (95% CI)

    • at baseline: 4.09 (3.31 to 4.86) vs 3.66 (2.92 to 4.40).

    • after treatment: 4.04 (3.25 to 4.83) vs 4.72 (3.72 to 5.72) p=0.04 for comparison of groups over time.

  • Anxiety; geometric mean score (95% CI)

    • at baseline: 8.05 (6.71 to 9.40) vs 7.91 (6.50 to 9.32).

    • after treatment: 5.49 (4.54 to 6.43) vs 5.24 (4.26 to 6.22) p=0.80 for comparison of groups over time.

  • Subgroup analysis for number of clinically anxious patients

    • at baseline: 14 patients with CA vs 11 patients with CA.

    • after treatment: 3 patients with CA vs 5 patients with CA.

    • Decline: intervention p=0.002; control p=0.014

  • Coping; geometric mean difference over time −0.7 vs 0.1 p=0.35

  • Empowerment; geometric mean difference over time 0.9 vs 0.9 p=0.47

GP-related outcome (intervention vs control)

  • GPs satisfied with communication: 82% vs 95%

  • GP confidence in managing:

    • side effects 85% vs 71% (p=0.45)

    • psychological issues 97% vs 81% (p=0.04)
Luker et al 24 Primary

  • Patient utilisation of the primary healthcare team (interview).

  • GP views after study (interview).

Measurements

  • at baseline (preoperative)

  • 4 months after diagnosis

 Uptake of intervention 8 of the 31 interviewed GPs recall seeing the information card
Healthcare use (intervention vs. control)

  • Patient initiated contact;

    • with GP ≥1 contact in 71% vs 73%, p=0.95.

    • district nurses no contact in 24% in both groups.

GP-related outcome (intervention)

  • Recommending information card 7 of 8 GPs who recall intervention.
Nielsen et al 16
Kousgaard et al 17 		Primary

  • Patient attitude towards the healthcare system: intersectoral cooperation and ‘not feeling left in limbo’ (SDQ).

  • Patient GP global assessment (one question)

  • Quality of life (EORTC QLQ-C30)

  • Performance status of function and self-care (ECOG).

  • Healthcare use: GP consultations (patient and GP reported SDQ).

  • GP assessment (SDQ) of:
    • Discharge information value
    • Own knowledge (patients confidence)
    • Own wishes to receive further information.
    • Intersectoral cooperation
Measurements
Patient:

  • First measurement ‘soon after the introduction of the intervention”(0 month).

  • 6 months

GP assessment: timing unknown		 Uptake of intervention Not reported
Patient-related outcomes (intervention vs control)

  • At 6 months: attitude towards intersectoral cooperation; 59.22 vs 51.71, p=0.055.

  • At 6 months ‘not feeling left in limbo’; 65.49 vs 55.58, p=0.055.

  • Patient GP global assessment;

    • at 0 months: 71.0 vs 58.68 (p=0.04).

    • at 6 months: 68.9 vs 64.02 (p=0.44).

  • Quality of life and performance status: nor relevant or significant differences described

Healthcare use (intervention vs. control)

  • GPs reported regular contact; 75% vs. 75%

  • Patient-reported GP consultation;

    • at 0 months: 67.8% vs 74.8% (p=0.583).

    • at 6 months: 38.0% vs 31.5% (p=0.046).

GP-related outcome (intervention vs. control)

  • Discharge information value GP on;

    • Psychosocial conditions 60% vs 26% (p<0.001).

    • Information their patient had received 84% vs 49%, (p<0.001).

  • GP knowledge 94.8% vs 96.6% (NS).

  • GP wish more information 21% vs 38% (p=0.009).

  • GP rate intersectoral cooperation ‘satisfactory’ 85% vs 73%, (p=0.033).

  • Intersectoral contacts: 25/100 vs 17/97 GPs had ≥1 contact, p=0.23.

CA, clinically anxious; CT, chemotherapy; Dan-PEP, Danish Patients Evaluate General Practice; ECOG, Eastern Cooperative Oncology Group; EORTC QLQ-C30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30; FACT-G, Functional Assessment of Cancer Therapy—General; GP, general practitioner; HADS, Hospital Anxiety and Depression Scale; Mini-MAC, Mini Mental Adjustment to Cancer Scale; NA-ACP, Needs Assessment for Advanced Cancer Patient; NS, not significant, no p-value or CI was provided nor could be calculated; OR adj, OR ratio adjusted for confounders sex and age; PACIC, Patient Assessment of Chronic Illness Care; PES, Patient Empowerment Scale; PHR, Patient Held Record; POMS, Profile of Mood States; SDQ, Self Developed Questionnaire; SCNS-SF34, Supportive Care Needs Survey Short Form 34; UC, usual care; y, years of age.