Physician-to-physician communication in breast cancer care coordination

Physician-to-physician communication in breast cancer care coordination

To cite this article: Héquet D, et al. Physician-to-physician communication in breast cancer care coordination. Bull Cancer (2017), http://dx.doi.org/...

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To cite this article: Héquet D, et al. Physician-to-physician communication in breast cancer care coordination. Bull Cancer (2017), http://dx.doi.org/10.1016/j.bulcan.2017.04.007 Bull Cancer 2017; //: ///

Physician-to-physician communication in breast cancer care coordination Communication médecin-médecin dans la prise en charge du cancer du sein Early stage breast cancer is considered a chronic disease. The management of different stages of the disease, from diagnosis to follow-up, involves many health professionals, including primary care physicians and hospital-based physicians. Efficient physician-to-physician communication is a key element in the patient centered care coordination. Everyone agrees on the full communication of the appropriate information concerning care to patients, but few data exist on physician-to-physician communication. Most of the studies evaluate communication between the primary care physicians and hospital-based physicians only at hospital discharge, and most of them show deficits in communication and information transfer [1–3]. The objective of this study was to evaluate physician-to-physician communication throughout the breast cancer endeavor, from both the primary care physicians and hospital-based physicians' perspectives. This study analyzed the results of 2 different questionnaires sent to hospital-based physicians and primary care physicians. Hospital-based physicians (surgical, medical and radiation oncologists) belonged to centers participating in the Optisoins01 study [4]. Optisoins01 was a French prospective, multicenter study conducted with early stage breast cancer patients from a defined regional health territory covering 35% of the population of the Île-de-France region (total population: 11.9 million). The principal objective of Optisoins01 was to identify the main care pathway of early breast cancer patients treated with initial surgery and to evaluate costs from different perspectives. This study was approved by the French National Ethics Committee (CCTIRS no. 14.602; CNIL DR-2014-167; registration number: NCT02813317). The objective of the present exploratory analysis was to evaluate quality of physician-to-physician communication and satisfaction about information of both primary care physicians and hospital-based physicians. Physicians involved in the management of breast cancer patients in the participating centers were asked to complete the questionnaire for hospitalbased physicians. At the inclusion visit, patients indicated the name and address of their primary care physicians, which was consistently a general practitioner. At the end of the inclusion

period, the listing of all primary care physicians was collected and the questionnaire for primary care physicians was sent by mail, with a pre-stamped envelope for the physicians to return the questionnaire. Primary care physicians were asked about the type of documents they receive from the hospital, and the frequency and satisfaction with communication. The analysis of the factors related to primary-care physicians' satisfaction with communication was performed with Fisher's exact test or Student's t-test. A multivariate analysis was conducted using a logistic regression model. Differences were considered significant at P < 0.05. All data analyses were performed using R software [5]. Six hundred patients were included in the Optisoins01 study and managed by 495 primary care physicians. Of the 495 questionnaires sent to the primary care physicians, 155 were answered, giving a 31% response rate. When asked about their involvement in breast cancer patients' management, 60.6% of the primary care physicians (n = 94) answered they worked in coordination with hospital, 29.7% (n = 46) declared to give a full devolution to the hospital for breast cancer patients' management and 6.5% (n = 10) considered themselves to be the breast cancer patients' referent. Thirty-nine hospital-based physicians completed the questionnaire. Hospital-based physician's characteristics, the type of information shared between physicians, and the frequency and satisfaction with communication are detailed in tables I and II. The surgeons seem to most frequently share full information (consultation report, examination results, treatment reports and multidisciplinary meeting reports) with primary care physicians (53.8%, n = 14), compared to medical oncologists (14.3%, n = 1) and radiation oncologists (0%, n = 0, P = 0.02), independent of the center type, the use of a report model or the number of patients managed per year by the physician. However, these results should be considered with caution because of the small sample of specialists interviewed in this study. The majority of the primary care physicians (82.6%, n = 128) were satisfied overall with hospital-based physicians communication (answered either "somewhat satisfied'' or "very satisfied'' to the question "How would you qualify your satisfaction with hospital-based physicians communication?''). Primary care physicians whose patients were cared for in a cancer center in first intention were more often satisfied overall (n = 90, 93.8%) than those who declared working in first intention with teaching hospitals (n = 16, 88.9%) and with general hospitals (n = 22, 75.9%, P = 0.021). We did not find any other statistically significant factor associated with primary care physician's satisfaction with communication.

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Letter to the Editor

en ligne sur / on line on www.em-consulte.com/revue/bulcan www.sciencedirect.com

BULCAN-391

To cite this article: Héquet D, et al. Physician-to-physician communication in breast cancer care coordination. Bull Cancer (2017), http://dx.doi.org/10.1016/j.bulcan.2017.04.007

Letter to the Editor

D. Héquet, N. Pouget, J. Seror, C. Huchon, M. Robain, A. Brédart, et al.

TABLE I

TABLE II

Hospital-based Physicians' characteristics and frequency of communication

Primary care physicians' characteristics, frequency of communication and satisfaction with communication

Hospital-based physicians (HBP), n = 39

Primary-care physicians (PCP), n = 155 n

n

%

Multidisciplinary meetings reports

131

84.5

% 1

Type of information from hospital

HBP characteristics Type of center Cancer center

13

33.3

Care plan

60

38.7

Teaching hospital

18

46.2

149

96.1

General hospital

8

20.5

Systematic report after every consultation in hospital Types of treatments received

71

45.8

Side-effects of the treatments

23

14.8

Hospitalization reports

144

92.9

Pathological reports

136

87.7

Operative reports

138

89.0

Examination results

51

32.9

Very dissatisfied

10

6.5

Somewhat dissatisfied

21

13.5

Somewhat satisfied

81

52.3

Very satisfied

43

27.7

Very dissatisfied

10

6.5

Somewhat dissatisfied

13

8.4

Somewhat satisfied

81

52.3

Very satisfied

51

32.9

Very dissatisfied

13

8.4

Somewhat dissatisfied

21

13.5

Somewhat satisfied

87

56.1

Very satisfied

33

21.3

NA

1

0.6

Very dissatisfied

10

6.5

Somewhat dissatisfied

24

15.5

Somewhat satisfied

77

49.7

Very satisfied

42

27.1

NA

2

1.3

Specialization Surgeon

26

66.7

Medical oncologist

9

23.1

Radiation oncologist

4

10.3

Activity (BC patients managed/year) < 50

8

20.5

50–99

7

17.9

100–199

8

20.5

 200

6

15.4

NA

10

25.6

Type of information shared systematically with PCP1 Consultation report

38

97.4

Examination results2

22

56.4

Treatment report

36

92.3

Multidisciplinary meeting report

28

71.8

Frequency of contacts with PCP (non-mailed)1 By phone Never

7

17.9

To obtain information

22

56.4

To give information

14

35.9

By e-mail Never

21

53.8

To obtain information

10

25.6

To give information

4

10.3

Satisfaction with communication Delay

Quality

Support

Frequency

1

Several responses possible. 2 Include biological results, pathology reports and imaging examination.

2

This study evaluated both primary care physicians and hospitalbased physicians on communication concerning breast cancer patients along the entire breast cancer pathway. Physicians interviewed reflect the current medical demographic reality of a large populated region in France. One of the limitations

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To cite this article: Héquet D, et al. Physician-to-physician communication in breast cancer care coordination. Bull Cancer (2017), http://dx.doi.org/10.1016/j.bulcan.2017.04.007

Primary-care physicians (PCP), n = 155 Overall satisfaction (very or somewhat satisfied)

128

82.6

Never

45

29.0

To obtain supplemental information

84

54.2

To obtain results of important events

53

34.2

Never

90

58.1

To obtain supplemental information

20

12.9

To obtain results of important events

15

9.7

Frequency of contacts with HBP (non-mailed)1 Phone

E-mail

1

and 1990s and the physician-to-physician relationship has changed since then [8]. Implementation of a common software tool will help to provide efficient, rapid and reliable communication. Finally, we found that primary care physicians were more often satisfied when referring patients to cancer centers. These centers usually have good resources such as medical assistants or strong computerized system. Cancer centers also have standardized care pathways and manage large volumes of patients, which help improve overall quality regarding physician-to-physician communication and cancer care coordination. Most of the primary care physicians were satisfied overall with hospital-based physicians' communication which is a key element in patient-centered care coordination. Funding: this study was supported by a grant from the French National Cancer Institute, dedicated to economic studies of innovative techniques. Delphine Hequet benefitted from a 'Fondation pour la Recherche Medicale' (FDM20140630453) grant to conduct this study.

Several responses possible.

of the study was the poor response rate of the primary care physicians. This limitation could lead to a selection bias because the responders could be the physicians more involved in breast cancer care coordination. However, this study included one of the largest primary care physicians' populations in the evaluation of physician-to-physician communication to date. Surgeons comprised the physician group who most consistently shared all needed documents with primary care physicians. The surgical period is shorter and planned compared to other medical visits, and this factor helps physicians to be more systematic in the reports and patients' visits. However, the analysis here reported points to the need to improve the communication of medical oncologists and radiation therapists with primary care physicians. One of the barriers in developing a good relationship between these physicians was the large number of primary care physicians managing breast cancer patients in the studied area (495 primary care physicians for 600 patients). Indeed, the development of a personal relationship between primary care physicians and hospital-based physicians has been shown to be one of the most important aspects to improve communication [2]. Despite these difficulties, primary care physicians were mostly satisfied with communication. These findings are in agreement with a study consisting of semi-structured interviews of general practitioners in the UK indicating a good relationship with specialists, based on mutual respect for one another [6]. A French study consisting in a systematic review of French journals highlighted the expectations of GP in terms of liaison letter at hospital discharge such as a summary of treatment, main diagnosis, and subsequent management [7]. However, these results contrast with most of the studies on this subject, indicating a global dissatisfaction of the primary care physicians. Importantly, most of these studies were published in the 1980s

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Disclosure of interest: the authors declare that they have no competing interest.

References [1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

Berendsen AJ, Benneker WH, Schuling J, Rijkers-Koorn N, Slaets JP, Meyboom-de Jong B. Collaboration with general practitioners: preferences of medical specialists – a qualitative study. BMC Health Serv Res 2006;6:155. Berendsen AJ, Benneker WH, Meyboom-de Jong B, Klazinga NS, Schuling J. Motives and preferences of general practitioners for new collaboration models with medical specialists: a qualitative study. BMC Health Serv Res 2007;7:4. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospitalbased and primary care physicians: implications for patient safety and continuity of care. JAMA 2007;297(8):831–41. Baffert S, Hoang HL, Brédart A, Asselain B, Alran S, Berseneff H, et al. The patient-breast cancer care pathway: how could it be optimized? BMC Cancer 2015;15:394. R Core Team (2012). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0. Available at:http://www.R-project.org/[http://lib.stat. cmu.edu/r/CRAN. Accessed July 20, 2016]. Marshall MN. How well do general practitioners and hospital consultants work together? A qualitative study of cooperation and conflict within the medical profession. Br J Gen Pract 1998;48(432):1379–82. Clanet R, Bansard M, Humbert X, Marie V, Raginel T. Systematic review of hospital discharge summaries and general practitioners' wishes. Sante Publ 2015;27(5):701–11. Kattel S, Manning DM, Erwin PJ, Wood H, Kashiwagi DT, Murad MH. Information transfer at hospital discharge: a systematic review. J Patient Saf 2016 [Epub ahead of print]. Delphine Héquet1,2,3, Nicolas Pouget1, Julien Seror1, Cyrille Huchon4, Mathieu Robain5, Anne Brédart6,7, Sandrine Baffert8, Roman Rouzier1,2 1

Centre René-Huguenin, institut Curie, département d'oncologie chirurgicale, 35, rue Dailly, 92210 Saint-Cloud, France 2 Centre René-Huguenin, institut Curie, Inserm U900 – cancer et génome : bioinformatique, biostatistiques et épidémiologie, 35, rue Dailly, 92210 Saint-Cloud, France

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TABLE II (Continued).

Letter to the Editor

Physician-to-physician com

To cite this article: Héquet D, et al. Physician-to-physician communication in breast cancer care coordination. Bull Cancer (2017), http://dx.doi.org/10.1016/j.bulcan.2017.04.007

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Letter to the Editor

D. Héquet, N. Pouget, J. Seror, C. Huchon, M. Robain, A. Brédart, et al.

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Université Paris-Sud, Gustave Roussy, école doctorale de cancérologie 418, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France 4 Hôpital de Poissy-Saint-Germain, département de gynecologie, 10, rue du Champ-Gaillard, 78300 Poissy, France 5 Institut Curie, Santé publique, 26, rue d'Ulm, 75005 Paris, France 6 Institut Curie, département interdisciplinaire de soins de support, 26, rue d'Ulm, 75248 Paris cedex 05, France 7 Université Paris-Descartes, LPPS EA 4057, 71, avenue Édouard-Vaillant, 92774 Boulogne-Billancourt cedex, France 8 Centre d'études et d'innovation en santé, Fondation A. de Rothschild, 25, rue Manin, 75940 Paris cedex 19, France

Correspondence: Delphine Héquet, Centre René-Huguenin, institut Curie, département d'oncologie chirurgicale, 35, rue Dailly, 92210 Saint-Cloud, France [email protected] Received 23 March 2017 Accepted 28 April 2017 Available online: http://dx.doi.org/10.1016/j.bulcan.2017.04.007 © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

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