1. BROOKLYN 2 RADIOTHERAPY Paul KANE Fri 30 th Aug 2013 Session 2 / Talk 4 11:20 – 11:40 ABSTRACT Cancer patients and their families in New Zealand frequently report that provision of support services is disjointed and subject to regional variation. The publication of the Implementation of Support Care guidance document by the Ministry of Health indicates this as a priority issue. A recent Cancer Society report indicates one factor is lack of clarity around the role of GPs here. Oncologists have varying and often ill-defined expectations in terms of the support that could or should be provided by GPs. Patients are often confused about who to refer to for care after specialist treatment has been completed. With confused lines of communication GPs appear to be “out of the loop”. The study highlighted core issues for GPs. These include; variable standards of communication with specialists and ideas how this can be improved; a belief that GPs have a significant role to play in support of patients; comparison with a range of chronic conditions to guide the role of GPs in the care for cancer patients; concerns over currency of their oncology knowledge; barriers to patients accessing GP services; limited awareness of services and information which may be of benefit to patients and discussion around cultural considerations pertinent to the NZ setting. GPs seem willing to engage in supporting patients manage their condition in the short and long term. Unsurprisingly there are barriers to that engagement. It is important to establish the perceptions of oncologists to complete the picture and construct viable pathways to improving overall service to patients.

2. THE ROLE OF GPS IN THE SUPPORTIVE CARE OF CANCER PATIENTS Kane P, Jasperse M, Egan R, Pullon S, McBain L, MacKinlay E. NZIMRT Conference 2013 Hamilton

3. Why did we do this study?

4. Life is a journey

5. The journey…with cancer…..

6. “…cancer’s chronic...“ (F6GP6)

8. Cancer Patient Oncologists GPs

9. Cancer Patient Oncologists GPs

10. Study Design Maori Consultation Ethical approval from MOH Multi-Region Committee Grounded Theory approach Interviews and focus groups with GPs across New Zealand (n=34) Transcription Line by line, constant comparison coding

11. ‘I’m happy to be involved…’ (I1GP1)

12. ‘I had no idea what was going on.... (with my patient) ’ (F5GP6)

13. Dear Doctor Jones, Mrs Cancer Patient has recently completed her treatment with me for Glioblastoma Multiforme. She was given 60Gy/30#/2Gy per #/5# per week/6weeks This was delivered concomittantly with a course of Temozolomide, Bevacizumab, Irinotecan followed by adjuvant chemotherapy of same over 6 months. She has been prescribed dexamethasone, 4gm/daily We will review Mrs Patient in 6 months. Regards Dr Oncologist ‘its not to us really, its their clinical notes’ (FG6GP1)

14. ‘…”Look, I’ve got some problem with diarrhoea” then we can look up in their last letter and it says: “Diarrhoea is very common…..this is how we manage it in our department” ……..we are able to treat them then’ (FG5GP3)

15. ‘I knew exactly what to do!’ F5GP6)

16. Summary Cancer becomes part of a patients life journey GPs are part of the patient journey Their role must be CLARIFIED Next step is to understand how oncologists view the role of GPs. Then develop workable solutions You can help!

17. Acknowledgements Cancer Society New Zealand - funding GP participants My collaborators and co-authors