Despite Being Involved in Cancer Treatment Decisions, PCPs Lack Knowledge, Confidence

As the healthcare system continues to strive to be patient-centered, team-based care has emerged as an important tool for improving quality of care and patient satisfaction, particularly in oncology. Within the care team, primary care providers (PCPs) play an integral role as they are often the provider managing the patient’s other comorbidities and general care, and thus they have a better understanding of the patient’s preferences and values. However, while patients often come to these providers first to discuss cancer treatment options, PCPs report significant knowledge gaps of these treatments.

According to a study in Cancer, one-third of PCPs reported participating in breast cancer treatment decisions with their patients, but a significant amount of them also indicated that they were not comfortable or did not feel that they had the necessary knowledge to participate in the treatment decision-making process.

“Primary care physicians may be involved in cancer care earlier than we thought,” Lauren P. Wallner, PhD, MPH, a health services researcher at the University of Michigan Rogel Cancer Center, said in a statement. “If we are going to promote their involvement, we may need to start doing that earlier, around the time of initial treatment, and ensure PCPs have the information they need to effectively participate in the decision-making process.”

Drawing on data from the Individualized Cancer Care study comprising 1077 women with early-stage breast cancer and their 517 providers, the researchers identified women aged 20 to 79 from Los Angeles County, California, and Georgia from 2013 and 2015. PCPs were asked whether they had discussed surgery, radiation, or chemotherapy options with their patients and how comfortable they were with doing so.

Survey answers revealed that 34% of PCPs had discussed surgery options with their patients, 23% discussed radiation, and 22% discussed chemotherapy. Across all 3 treatment options, PCPs who reported ability to participate in the decision-making process were more likely to have these discussions and have them more often.

However, the survey also revealed that among PCPs who discussed surgery options with their patients, 22% reported not being comfortable having those conversations, 17% reported that they did not have the necessary knowledge to do so, and 18% reported that they lacked the confidence to do so.

Similar findings were seen across the other 2 treatment options. Sixteen percent of PCPs who discussed radiation with their patients reported that they were not comfortable having those discussions, 9% reported not having the knowledge to help with these discussions, and 14% reported that they lacked the confidence to do so. Among PCPs who discussed chemotherapy with patients, 1 in 4 reported not being comfortable, 9% reported not having the knowledge, and 16% reported not having the confidence to help with these decisions.

Reflecting on these findings, the researchers emphasized the need for efforts to better incorporate and communicate with PCPs and to educate them about the specifics of cancer treatments.

Reference:

Wallner L, Li Y, McLeod M, et al. Primary care provider-reported involvement in breast cancer treatment decisions [published online February 1, 2019]. Cancer. doi: doi.org/10.1002/cncr.31998.