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Addressing psychological issues – the role of the Primary Care Practitioner

Watch this video to hear from leading experts in the field about how to identify and manage physiological and psychological needs of cancer survivors.
The psychological support need of cancer survivors, I’m not sure if the primary care physician has a major role. At least not in the Netherlands. I mean, what I understand from general practitioners is that they find it more comfortable to focus on the symptoms and on co-morbidities. And treatment of co-morbidities rather than focusing on psychological care. And in conversations that I have with GPs and also in the research, they try to sort of refer patients to psychologists rather than looking at that themselves. They prefer to see themselves as a keeper for co-morbidities and long term effects of treatments, more than doing psychological support. At least that’s the situation in the Netherlands.
I think currently and in the immediate future, the role will mainly be around patients’ physical needs. Because that’s what patients consult with us. And it might be physical problems that they’re having during their treatment phase with the chemotherapy or during radiotherapy treatment. And it might be following that with the consequences of the treatment or of that condition itself. And so if a patient will then also talk about psychological needs, or anxiety, or fear of recurrence, then I’m sure the primary carer will be quite able to meet those needs. But it’s quite difficult to address all that in the 10 minute consultation, which is what’s currently what most GPs work to in the UK.
I think that primary care is probably better set up to actually deal with the psychological implications of chronic diseases, because they’ve been doing it all along. There is a little bit of a block in terms of cancer being perceived as being a fundamentally different problem than, say, heart disease. But the underlying psychological mechanisms, particularly around the risk of recurrence, are probably quite similar. And I think that because of the fact that family physicians and primary care teams already have so much training in terms of developing a trusting relationship and being able to engage with individuals to discuss topics that they might otherwise not discuss.
They probably are in the best position to, in particular, support individuals who need a low level of support. And identify individuals who are really getting into problems. Because I don’t think that we’re as good at doing that in the oncology settings, quite frankly. Cancer survivors do face a lot of psychosocial issues, particularly anxiety around the cancer coming back. But also anxiety and depression, particularly with patients who’s cancer has recurred. So general health practitioners are expert at dealing with mental health issues. They provide that sort of support to the general community. And they can play an important role in dealing with this within the cancer context as well.
Patients often feel more comfortable talking about those sorts of issues with their general health practitioner, who may have a better understanding of their social circumstances and where they’ve come from. So I see the GP and the health care team around the GPs being critical in that care. Addressing psychological support for cancer survivors is an important area, and one that primary care clinicians really have a great deal of experience doing in the regular practises. This is, in general, a strong area for primary care. And just being aware, and asking about, and being willing to deal with those challenges in the survivor community is really important. But one that should fit in relatively easy and to most primary care practises.
What is the role of the Primary Care Practitioner in addressing common psychological issues for cancer survivors?

As you have heard in the video there are many different perspectives to the role of the PCP in addressing psychological issues for cancer survivors.

In the Netherlands it was noted that PCPs typically feel more comfortable addressing and treating symptoms and co-morbidities, and tend to refer their patients to psychologists for psychological care.

We heard that in the UK, PCPs also tend to focus more on helping patients with physical problems associated with the treatment or consequences of the treatment, or the cancer itself. Although PCPs are comfortable and able to meet the psychological needs of their patients, there is just not enough time in the standard 10 minute consultation to which most GPs work to in the UK.

It was also noted, that PCPs are probably better set up to deal with psychological implications of chronic diseases, and that there is probably similarity in the nature of psychological issues in chronic diseases such as heart disease or cancer e.g. the risk of recurrence.

What are your thoughts? Do you think the role of PCPs in addressing psychological issues of their patients depends on where they live? What is your role, or what have you experienced the PCP’s role is when it comes advising the survivor on common psychological issues?

Post your thoughts in the comments section below.

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Cancer Survivorship for Primary Care Practitioners

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