Patients’ experiences with general practitioner-led colon cancer survivorship care; a mixed-methods evaluation at various time points.

Background: Colon cancer survivorship care constitutes both follow-up and aftercare. General practitioner (GP) involvement may help to personalize care. Aim: To address patients’ experiences with GP- versus surgeon-led survivorship care. Design and setting: Stage I-III colon cancer patients were recruited from 8 Dutch hospitals and randomised to receive care by either the GP or surgeon. Method: A mixed-methods approach was used to compare GP- to surgeon-led care, consisting of questionnaire-based data (N=261) and semi-structured interviews (N = 25). After 1 year, the Consumer Quality Index (CQI) was used to measure quality aspects of care. Interviews were performed at various time points (3 to 6 years after surgery) to explore patients’ experiences more in-depth. Results: Overall, patients were satisfied with both GP- and surgeon-led care (ratings 9.6 versus 9.4 out of 10 respectively). No important differences were seen in quality of care as measured by CQI. Interviews revealed that patients often had little expectations of care from either healthcare professional. They described follow-up consultations as short, medically oriented and centered around discussing follow-up test results. Patients also reported little symptoms. Care for patients in the GP-led group was organized in different ways, ranging from solely on patient’s initiative to shared care. Patients sometimes desired a more guiding role from their GP, whereas others preferred to be proactive themselves. Conclusion: Patients experience high quality of colon cancer survivorship care from either GP or surgeon. If the GP is going to be more involved, patients require a clear understanding of roles and responsibilities.