Good cancer follow-up for socially disadvantaged patients in general practice? Perspectives from patients and general practitioners

Abstract

One of the core principles of providing care in general practice is giving more to those who need it most. We investigate some of the complexities of this ambition in the context of cancer care for patients defined as socially disadvantaged by their general practitioner (GP). We do this by exploring how care is sought, how it is offered, and what expectations patients and GPs carry with them when receiving and providing cancer care in the Danish welfare state. We carried out semi-structured interviews with eight GPs and seven socially disadvantaged cancer patients living with different types and stages of cancer. The interviews focused on needs and challenges in cancer follow-up in general practice and were thematically coded. Drawing on theoretical concepts of morality and Nordic individualism, we point to how one of the main challenges in cancer care and follow-up is to figure out how the doctor-patient relationship should be established, practiced, and maintained. Both GPs and patients stressed the importance of the relationship, but how it should be practiced amidst social norms about being a patient, a citizen and how care-seeking should unfold seems less clear. In conclusion we argue that giving more to those who need it the most is a difficult and ill-defined task that is shaped by the cultural, social, and political expectations of both GPs and patients.

Keywords:

• Socially disadvantaged
• cancer care
• general practice
• nordic individualism
• qualitative

Acknowledgments

The authors would like to thank the patients who were interviewed for their time and contribution. We would also like to thank the interviewed GPs for their time and contribution, and for providing contact to the patients.

Authors’ contributions

The conception and design of the study was planned by both authors. The data were generated by the first author. The analysis was conducted primarily by the first author, guided by the second author. Results were developed together by both authors.

Disclosure statement

The authors report there are no competing interests to declare.

Ethical approval

This study needed no approval from an ethical board approval because it did not contain human or animal trials but is based on self-reported data. The project was registered in the record of processing activities at Aalborg University in accordance with the provisions of the General Data Protection Regulation (GDPR) of the European Union. All participants provided written informed consent prior to enrolment in the study. Identifying information, such as names or specific locations, have been anonymized to ensure participant safety and privacy.

Data availability statement

The datasets generated during and analysed during the current study are available from the corresponding author on reasonable request.

Notes

1 Single-handed type: an individual/solo practice. Partnership type: a practice with more GPs in the same clinic, in partnership or cooperation.

Additional information

Funding

This work was funded by the ‘Cancer Group’ at the Quality Unit for General Practice in the North Denmark Region, grant number 844776