GPs' Insights into Prostate Cancer Diagnosis and Care in Regional Victoria, Australia

By Ruseckaite, Rasa; Evans, Sue et al. | The Qualitative Report, December 2016 | Go to article overview

GPs' Insights into Prostate Cancer Diagnosis and Care in Regional Victoria, Australia


Ruseckaite, Rasa, Evans, Sue, Millar, Jeremy, Holton, Sara, Mazza, Danielle, Fisher, Jane, Kirkman, Maggie, The Qualitative Report


Prostate cancer (PCa) is the most commonly diagnosed and prevalent tumour reported to cancer registries in Australia and globally (Smith et al., 2009; Evans et al., 2013). While long term survival following a diagnosis of PCa is relatively good (~92% at 5 years), there is considerable morbidity associated with the treatment and management of PCa. Survival differs according to disease stage at diagnosis. There is evidence that patients with locally advanced disease (as denoted by a prostate specific-antigen [PSA] level of greater than 10ng/mL, local histologic findings, and stage) will benefit from surgical treatment compared with men who have no active treatment (Wilt et al., 2012). Health-related quality of life (QoL) outcomes after treatment are of critical concern to patients, their partners, and physicians (Glaser et al., 2013; Lev et al., 2004; Skevington & McCrate, 2012; Smith et al., 2009; Storas et al., 2014; Wei et al., 2002).

It is important to detect prostate cancer as early as possible to enable optimum outcomes and potential cure. General Practitioners (GPs) are often the first health professionals to hold discussions with men about whether to undertake screening of PCa and, following diagnosis, which treatment to choose. A key role of GPs is to ensure that screening and treatment options have been explained to and understood by the patient and to act as the patient's advocate in choosing the most appropriate treatment.

GPs are usually also involved in post-treatment care, including managing comorbidities, monitoring disease recurrence and side-effects of treatment, and provision of psychosocial support. According to Emery (2014), good "survivorship" care requires clear channels of communication among the specialist, GP, and patient. The provision by GPs of good communication, clear guidance, and access to specialist care may reduce the reliance on specialists by many cancer survivors. Longitudinal data from the UK on nearly 5000 survivors with PCa (alive at least 5 years post diagnosis) showed that survivors consulted their GP up to three more times annually compared to healthy controls matched on the basis of age, sex, and primary care practice (Khan, Watson, & Rose, 2011). A similar study in the Netherlands showed that men with PCa see their GP more than controls at 2-5 years after diagnosis for both cancer-related health problems and disease management (Heins, Korevaar, Rijken, & Schellevis, 2013).

Previous studies have revealed high variability in PCa screening habits and techniques amongst GPs (Crowe, Wooten, & Howard, 2015; Drummond , Carsin, Sharp, & Comber 2009; Bowen, Hannon, Harris, & Martin, 2011; Tasian et al., 2012). Broadly, PCa screening approaches can be classified into two categories: (1) GPs who routinely scan patients they believe to be at risk of PCa, and (2) GPs who scan patients in response to a request or to a patient's troubling symptoms (Drummond et al. 2009; Bowen et al. 2011; Crowe, Wootten, & Howard, 2015). Many factors might contribute to this variability. Bowen et al. (2011) noted that common concerns among GPs not detecting PCa at an early stage included the resulting legal ramifications and/or mortalities. Another concern possibly contributing to variability in PCa screening habits was GPs' lack of clarity about when screening for PCa is appropriate (Crowe, Wootten, & Howard, 2015; Drummond et al., 2009).

Variability in clinical guidelines in Australia and overseas is also believed to contribute to GPs' inconsistent screening techniques (Bowen et al. 2011; Crowe, Wootten, & Howard, 2015; Drummond et al., 2009; Jessen, Sondergaard, Larsen, & Thomsen 2013). Identified causes of deviations from established PCa screening guidelines potentially include insufficiently clear guidelines, patient requests for screening, past experience with men diagnosed with PCa, various co-morbidities, and the fear of litigation by and mortality of men with PCa. …

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GPs' Insights into Prostate Cancer Diagnosis and Care in Regional Victoria, Australia
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