Abstract
Background: Specialist-led cancer follow-up is becoming increasingly expensive and is failing to meet many survivors’ needs. Alternative models informed by survivors’ preferences are urgently needed. It is unknown if follow-up preferences differ by cancer type. We conducted the first study to assess British cancer survivors’ follow-up preferences, and the first anywhere to compare preferences of survivors from different cancers.
Methods: A discrete choice experiment questionnaire was mailed to 1,201 adults in Northeast Scotland surviving melanoma, breast, prostate or colorectal cancer. Preferences and trade-offs for attributes of cancer follow-up were explored, overall and by cancer site.
Results: 668 (56.6%) recipients (132 melanoma; 213 breast; 158 prostate; 165 colorectal) responded. Cancer survivors had a strong preference to see a consultant during a face-to-face appointment when receiving cancer follow-up. However, cancer survivors appeared willing to accept follow-up from specialist nurses, registrars or GPs provided that they are compensated by increased continuity of care, dietary advice and one-to-one counselling. Longer appointments were also valued. Telephone and web-based follow-up and group counselling, were not considered desirable. Survivors of colorectal cancer and melanoma would see any alternative provider for greater continuity, whereas breast cancer survivors wished to see a registrar or specialist nurse, and prostate cancer survivors, a general practitioner.
Conclusion: Cancer survivors may accept non-consultant follow-up if compensated with changes elsewhere. Care continuity was sufficient compensation for most cancers. Given practicalities, costs, and the potential to develop continuous care, specialist nurse-led cancer follow-up may be attractive.
Methods: A discrete choice experiment questionnaire was mailed to 1,201 adults in Northeast Scotland surviving melanoma, breast, prostate or colorectal cancer. Preferences and trade-offs for attributes of cancer follow-up were explored, overall and by cancer site.
Results: 668 (56.6%) recipients (132 melanoma; 213 breast; 158 prostate; 165 colorectal) responded. Cancer survivors had a strong preference to see a consultant during a face-to-face appointment when receiving cancer follow-up. However, cancer survivors appeared willing to accept follow-up from specialist nurses, registrars or GPs provided that they are compensated by increased continuity of care, dietary advice and one-to-one counselling. Longer appointments were also valued. Telephone and web-based follow-up and group counselling, were not considered desirable. Survivors of colorectal cancer and melanoma would see any alternative provider for greater continuity, whereas breast cancer survivors wished to see a registrar or specialist nurse, and prostate cancer survivors, a general practitioner.
Conclusion: Cancer survivors may accept non-consultant follow-up if compensated with changes elsewhere. Care continuity was sufficient compensation for most cancers. Given practicalities, costs, and the potential to develop continuous care, specialist nurse-led cancer follow-up may be attractive.
Original language | English |
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Pages (from-to) | 1495-1503 |
Number of pages | 9 |
Journal | British Journal of Cancer |
Volume | 115 |
Issue number | 12 |
Early online date | 1 Nov 2016 |
DOIs | |
Publication status | Published - 6 Dec 2016 |
Bibliographical note
We wish to acknowledge the time taken by our participants in the study. We also thank: Amanda Cardy of the Scottish Primary Care Research Network who assisted MPM in administering the questionnaire mailings; Mrs Hazel Riley, CAPC, University of Aberdeen, who assisted MPM with data entry; Drs Graham Macdonald, Marianne Nicolson, Leslie Samuel and Radha Todd, cancer specialists working at Aberdeen Royal Infirmary, who supported us by generating lists of their clinic attendees and screening the lists of potential recipients; Dr Verity Watson, HERU, University of Aberdeen who provided advice and support to MPM in the conduct of the analysis.Keywords
- cancer
- survivorship
- follow-up
- primary care
- discrete choice experiment
- patient preferences
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Peter Murchie, BSc (Med Sci), MBChB, MSc, MRCGP, CertMgmt (Open), PhD
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Personal Chair (Clinical)
- Institute of Applied Health Sciences
Person: Clinical Academic
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Patricia Norwood
- School of Medicine, Medical Sciences & Nutrition, Health Economics Research Unit - Advanced Research Fellow
Person: Academic Related - Research
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Mandy Ryan
- School of Medicine, Medical Sciences & Nutrition, Health Economics Research Unit - Director of H E R U
- Institute of Applied Health Sciences
Person: Academic