Short summary

Can a new innovative intervention that brings the patient, the oncologist and general practitioner together in a shared video-consultation in the early phase of chemotherapeutic treatment improve continuity of cancer care as perceived by both patients and healthcare providers?

The effect of the intervention in addition to usual care will be tested in a randomised controlled trial. Results and process outcomes will be evaluated qualitatively and quantitatively, using footage of the consultations, questionnaires to patients, general practitioners and oncologists, and data from registers.

Rationale

International guidelines underline the importance of strengthening the coordination and continuity of cancer care. The different roles of general practitioners and oncologists with regard to treatment, follow-up and rehabilitation during and after cancer treatment are often obscure to cancer patients. Parallel courses of healthcare are often taking place instead of coordinated care characterised by continuity and partnership between care providers. Healthcare-seeking and support during and after cancer treatment may, therefore, be inappropriate, leaving patients feeling insecure and lost between care providers.

The aim of the study is, to design and evaluate a new way of communication and shared decision-making that brings the patient, the oncologist and GP together in a shared video consultation. A multi-modal intervention will be evaluated in a randomised controlled trial.

Description of the cohort

Patients will be recruited at the Department of Oncology, Vejle Hospital, at their first appointment for chemotherapy. In 2013 the Department had 1.200 referrals and started chemotherapies. The five most frequent diagnoses were breast, gastrointestinal, pulmonary, gynaecological, and urinary cancer. During the inclusion period all adult patients referred for chemotherapy will be invited for the study regardless of cancer type.

Data and biological material

Data will be retrieved from registers and internet-based questionnaires to patients at baseline and after 4 and 7 months and to GPs and oncologists at 4 months. All handling of the questionnaires will be managed using the software program RedCap. The initial part of the questionnaire at baseline will include demographic and clinical information like age, cancer type, cancer recurrence status, and completion of previous chemotherapy treatment.

The primary study outcome is the total score of the decision self-efficacy scale for patients at 7 month. This 11-item questionnaire has previously been translated from English to Danish and used in a Danish, mixed oncology setting

Secondary outcomes covering patients perspectives will include the following questionnaires: Global Health Status of the EORTC QLQ C-30 subscales and single items of the EORTC QOL C-30 which has high validity, knowledge from reference populations and strong correlation to unmet needs of rehabilitation., Cancer Care Coordination Questionnaire (CCCQ) consisting of 22 items, The Illness Intrusiveness Rating Scale (IIRS) assessing the extent to which an illness or its treatment is viewed as interfering with different aspects of an individual's life , EORTC QLQ INPAT32 covering oncology patient satisfaction with their cancer trajectory and EORTC QLQ INFO 25 covering several aspects of patient information during cancer treatment. Additionally, health-seeking behaviour to the general practitioner and the oncologic department (contact form, date and aim) will be asked about.

Patients in the intervention group will additionally evaluate the content, form, expectation and experience of the video consultation. This is achieved by presenting them to ad hoc items inspired among others by the work of the Australian College of Rural & Remote Medicine.

In addition to patients' evaluation of health, health-seeking behaviour and the care given, evaluations from the GPs and the oncologists primarily responsible for their treatment are included as secondary outcomes. Until now, we are not aware of appropriate validated scales and therefore ad hoc item will be formulated to cover perceived benefit of the video-consultation, subsequent influence on care and coordination, satisfaction with own care, relevance of patient contacts, comorbidity care and adherence to cancer care.

Data from registers will include the National Patient Register, National Health Insurance Register (Statistics Denmark).

Collaborating researchers and departments

National Research Center of Cancer Rehabilitation, Research Unit of General Practice, University of Southern Denmark

• Head of Center and Associated Professor Dorte Gilså Hansen, MD, PhD

Department of Oncology, Vejle Hospital

• Clinical director Lars Henrik Jensen, MD, PhD

Research Unit of General Practice, University of Southern Denmark

• Head of Research Unit and Professor Jens Søndergaard, MD, PhD

Faculties of Medicine and Dentistry, University of Manitoba, Winnipeg, Canada

• Associate Dean Jeffrey Sisler, MD