The general practitioner’s role in cancer rehabilitation:
a randomised, controlled trial
Stinne Holm Bergholdt, PhD student, MD Research Unit for General Practice, Odense
The Presentation
• Aim and methods of the RCT
• Feasibility of the intervention
• Preliminary results from the GP questionnaire
• Status
Ongoing analysis of data from the patient and GP questionnaires
Background
• Various unmet needs for rehabilitation among cancer patients
• Lack of knowledge about
• effective interventions
• how to organise and carry out the different rehabilitation services
• where to place the responsibility for each patient’s course of rehabilitation (general practice?)
Aim of the RCT
To estimate the effect of a targeted effort to involve and motivate the GP to get proactively involved in cancer patients’ physical,
psychological, social and work-related
rehabilitation on the patients' quality of Life
Primary outcome
Patients’ Health Related Quality of Life
• EORTC QLQ C-30 questionnaire at 6 months after diagnosis
Secondary outcomes
• Degree of proactive behaviour among GPs
• Patients’ satisfaction with the GP’s contribution to the
course of rehabilitation
• Number of sick days among patients on the labour market
The Danish Healthcare System
• Publicly funded primarily through taxes
• More than 98% of the population are listed with a GP
• Free access to general practice, outpatient and hospital care for all citizens
• GPs are gatekeepers for hospital and practicing specialist services
Setting
Vejle
Odense
Red : The Region of Southern Denmark (1.2 million inhabitants)
Vejle Hospital (Rehabilitation Coordinators) The Research Unit for General Practice
In Odense
GPs of all included patients
Methods
• Randomised, controlled trial
• All general practices in Denmark were randomised based on provider number
• Included patients were allocated based on the randomisation status of their GP
Study profile
• Usual care and communication between hospital and GP
• No contact or interview by the RC
• No specific or systematic focus on rehabilitation from the
hospital staff 1896 patients assessed for eligibility
955 patients met the inclusion criteria
486 intervention group 469 control group
↓
↘
↙
Patient interview with RC in order to
• introduce the concept of rehabilitation
• identify rehabilitation needs Personal contact to the GP by the RC
• telephone and e-mail
• individual and general information about rehabilitation needs
• encouragement to be proactive
Inclusion criteria
• Patients diagnosed with a new cancer disorder from May 2008 to February 2009
• Ageed above 18
• diagnosed < 3 months earlier
• not recurrence of a previously treated cancer
• cancer treatment at Vejle Hospital
• listed with a GP
• Patients diagnosed with carcinoma in situ and non-melanoma skin cancer were not included
Follow-up
Patient questionnaires
6 and 14 months after diagnosis
• Quality of Life
• Satisfaction with own rehabilitation
• GP’s contribution to the rehabilitation
Follow-up
Questionnaires to GPs
14 months after the patient’s diagnosis
• degree of proactive behaviour
• satisfaction with own effort
• collaboration with hospital Register data
• number of sick days
(patients of working age)
• diagnosis, cancer stage, etc.
Feasibility of the intervention:
the patient interview
At the hospital, the patient alone;
34%
At the hospital, with relatives;
15%
Over phone; 31%
Contact to patient not possible; 19%
Missing information; 1%
n=478
Feasibility of the intervention:
the personal contact to GP
Yes 44%
No 31%
No rehabilitation
needs, email sent to GP
20%
Missing information
3%
Contact to GP declined by the
patient 2%
n=473
How positive was the GP to the telephone contact about rehabilitation?
N=1990%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Extremely Very Moderately Slightly Not at all
Feasibility study: Conclusions
• The GPs are very interested in their cancer patients and how to optimize their course of rehabilitation
• 80% of the patients received the intervention
• 85% of the practice units were contacted personally by the RCs
Preliminary results from the GP questionnaire
Response rate 85%
Proactive behaviour among the GPs
p= 0.096
“Have you ever contacted the patient yourself to suggest a consultation about the course of the disease and its consequences?”
Control group Intervention group
Never 45% 39%
Yes
(once + several times)
55% 61%
Information from hospital to GP
p= 0.0001
”Did you receive satisfactory information from the hospital about the patients needs for psychosocial rehabilitation?”
Control group Intervention group No
(to a low extent + not at all) 60% 46%
Yes
(to some extent + to a great extent) 40% 54%
The RCT: Conclusions at GP level
• The intervention seems to have an effect on the degree of proactive behaviour among the GPs, however not significant
• 55% of the GPs were proactive, independent of the intervention
• The intervention improved the information from the hospital to the GPs about the patients’ psychosocial rehabilitation needs
• The ongoing analyses will reveal whether this effect has any impact at patient level
