Improvement of decision-making criteria for the care of elderly cancer patients by general practitioners (Lorraine, France)

Abstract

Jean-Yves Niemier,1,2 Frédérique Claudot,3,4 Phi Linh Nguyen-Thi,4 Jean-Marie Hubert,5 Hubert Rousselot,2,6 Athanase Benetos,1 Christine Perret-Guillaume1,3 1Department of Geriatric Medicine, CHRU de Nancy, Nancy, France; 2UCOG Lorraine, Nancy, France; 3EA 4360 APEMAC, Faculté de Médecine, Université de Lorraine, Nancy, France; 4PARC, CHRU de Nancy, Nancy, France; 5Spincourt Multidisciplinary MSP, Spincourt, France; 6SISSPO Department, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France Objective: The objective of this study was to identify changes in the decision-making criteria of general practitioners (GPs) concerning the care of elderly cancer patients after 1 year of corrective measures for care practices in the Lorraine region, France. Materials and methods: In 2014, a postal mail questionnaire was sent to all GPs in the Lorraine region. This questionnaire was designed to identify GPs’ decision-making criteria. It was based on the results of a literature review and on existing guidelines. During 1 year, corrective measures were implemented to improve practices, especially training sessions for physicians and production of specific tools, including a guide to the accepted ideas in geriatric oncology. In 2015, the same questionnaire was resent to all GPs to compare the answers. Results: In 2014, 430 questionnaires were returned out of 2,048 sent, and in 2015, 378 questionnaires were returned out of 2,066 sent. Our results show for the first time that there exists a significant difference in the overall decision criteria between the two survey periods. This difference mainly concerns criteria related to the cancerous diseases. Physicians tend to consider the principal decision criteria to be less important after the training period. GPs express the importance of accessibility to specialists for additional advice in both 2014 and 2015; the distance between the patient’s home and an adapted care facility and the interval before care begins are viewed as similarly important. Conclusion: Training and information sessions for physicians remain the most important tool for improving care practices. Such training strategies are more effective when carried out at the geographical scale at which the cancer professionals practice, allowing them to exploit their local organizational structure. The analysis of our data makes it possible to further integrate the patient into the care path, which remains a public health issue in terms of cost and organization. Keywords: elderly, cancer, general practitioner, treatment decision-making, care improvement, older people, tumors, physician, management, ethics

Keywords

• Elderly – Cancer – General practioner – Treatment Decision making – Care improvement