Primary care physicians on caring for patients with complex comorbidities and history of breast cancer

Background There have been calls for primary care physicians (PCPs) to take a greater role in the care of their patients with a history of cancer; however, little is known about PCPs’ perspectives on integrating cancer survivorship recommendations into practice. We sought to understand the perspectives of PCPs in the United States on caring for patients with a history of breast cancer and multiple chronic conditions, breast cancer survivorship recommendations, and approaches to improve care for these patients. Methods As part of a larger NCI-funded study, we iteratively interviewed and analyzed a purposeful sample of eight PCPs from diverse settings using qualitative, semi-structured interviews. We used a clinical vignette to ask participants about care for a hypothetical patient with multiple chronic conditions and a history of breast cancer, followed by questions about integrating breast cancer survivorship recommendations into routine practice, and potential solutions to obstacles. We used an editing organizing style of analysis to identify overarching patterns and themes across interviews. Results Consistent themes emerged across eight interviews about PCPs’ perspectives on integrating care for patients with a history of cancer into practice: (1) PCPs perceive their role as providing whole-person, patient-centered care; (2) Most breast cancer survivorship recommendations are within the scope of primary care; (3) Delineation of roles and responsibilities in the care of cancer survivors is unclear; (4) PCPs rarely receive actionable and accessible information from oncology teams and must piece together information from multiple sources to make informed decisions. Conclusion Poor delineation of roles and lack of actionable and accessible information hinder incorporating some aspects of survivorship into primary care practices. Local resources and actionable information may support better integration of survivorship care in primary care.