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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

Shared care in the follow-up of early-stage melanoma: a qualitative study of Australian melanoma clinicians’ perspectives and models of care

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2012
Autoren:
Lucie Rychetnik, Rachael L Morton, Kirsten McCaffery, John F Thompson, Scott W Menzies, Les Irwig
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-468) contains supplementary material, which is available to authorized users.

Competing interests

The authors have no financial, commercial or other competing interests.

Authors’ contributions

All authors contributed to the conception and design of the study and acquisition of the data. LR, RM and KM collaborated on the analysis and interpretation of data, with substantive contributions from LI, JT and SM. LR drafted and revised the manuscript, with all other authors providing critical feedback on important intellectual content resulting in substantial revisions. All authors read and approved the final manuscript.

Abstract

Background

Patients with early stage melanoma have high survival rates but require long-term follow-up to detect recurrences and/or new primary tumours. Shared care between melanoma specialists and general practitioners is an increasingly important approach to meeting the needs of a growing population of melanoma survivors.

Methods

In-depth qualitative study based on semi-structured interviews with 16 clinicians (surgical oncologists, dermatologists and melanoma unit GPs) who conduct post-treatment follow-up at two of Australia’s largest specialist referral melanoma treatment and diagnosis units. Interviews were recorded, transcribed and analysed to identify approaches to shared care in follow-up, variations in practice, and explanations of these.

Results

Melanoma unit clinicians utilised shared care in the follow-up of patients with early stage melanoma. Schedules were determined by patients’ clinical risk profiles. Final arrangements for delivery of those schedules (by whom and where) were influenced by additional psychosocial, professional and organizational considerations. Four models of shared care were described: (a) surgical oncologist alternating with dermatologist (in-house or local to patient); (b) melanoma unit dermatologist and other local doctor (e.g. family physician); (c) surgical oncologist and local doctor; or (d) melanoma physician and local doctor.

Conclusions

These models of shared care offer alternative solutions to managing the requirements for long-term follow-up of a growing number of patients with stage I/II melanoma, and warrant further comparative evaluation of outcomes in clinical trials, with detailed cost/benefit analyses.
Zusatzmaterial
Authors’ original file for figure 1
12913_2012_2365_MOESM1_ESM.pdf
Authors’ original file for figure 2
12913_2012_2365_MOESM2_ESM.pdf
Literatur
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