Opportunities to improve quality of care for cancer survivors in primary care: findings from the BETTER WISE study

Contrary to the name, prevention practitioners may play an important role in cancer survivorship within primary care. Originally, prevention practitioners (non-physician health professionals) had successfully worked with GPs and patients in improving cancer screening and prevention through the BETTER trial. The subsequent BETTER WISE trial expanded into the area of cancer survivorship. It tested the effectiveness of prevention practitioners in cancer surveillance and recurrence in survivors ā€“ a major domain in cancer survivorship.   Firstly, nine high quality cancer survivorship guidelines for breast, prostate, and colorectal cancers were combined into a single algorithm, including recommendations around surveillance testing, care plans, and mental health management. Then, a cluster randomised trial recruited primary care patients from 60 GPs across 13 general practices in Canada. The 115 participants comprised cancer survivors who either received usual care, or 6-monthly personalised visits with a prevention practitioner about undertaking cancer prevention, screening, and surveillance actions. Success was evaluated by the proportion of actions taken at the 12-month follow up timepoint compared to the total number of actions provided at baseline, between the control arm to the intervention arm. Focus groups, interviews, and surveys were also conducted for further context.   Unfortunately, the qualitative data revealed that the trial recruitment and follow up were highly affected by the COVID-19 pandemic; results were also underpowered. The quantitative findings demonstrated that there was no difference between control and intervention arms. However, both patients and GPs supported the inclusion of prevention practitioners in survivorship care. Prevention practitioners improved coordination of care with specialists, and patient engagement around cancer surveillance. Given the important role of primary care in cancer survivorsā€™ journeys, and the lack of support and capacity that GPs face due to system-level issues, prevention practitioners may be a promising solution for cancer survivors in primary care within a healthcare system under pressure.   Read the original article here.
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