The purpose of this study was to find out, from the patient's perspective and using qualitative methodology, how cancer follow-up care is managed in a New Brunswick health region. From focus group discussions with 23 participants 1-year post-cancer diagnosis, 3 prominent themes emerged: fear of recurrence, cancer surveillance/testing and support issues. The fear of recurrence permeates day-to-day life for many patients. To allay these fears, some patients feel a need to be subjected to extensive cancer surveillance. Emotional support, which is important for survivors, is complex. The majority of the participants in this study received cancer follow-up care from specialists. More rural than urban participants received their follow-up care from their family physicians (FPs). Participants had high expectations for follow-up care, regardless of which type of physician--specialist or FP--provided it. If physicians did not provide the level and intensity of care expected by their patients, they were considered uncaring. We advocate a "transition of care" or "shared care" protocol between the acute cancer treatment provider and the FP, particularly in rural areas. This would ensure that cancer patients have a clear understanding of where to turn for ongoing surveillance, when they fear cancer recurrence or need support. For optimized cancer follow-up care, physicians must be cognizant that careful emotional and clinical management over an indefinite period of time is required, and they must recognize the individual needs of each patient.
To assess family physicians' and specialists' involvement in cancer follow-up care and how this involvement is perceived by cancer patients.
A health region in New Brunswick.
A nonprobability cluster sample of 183 participants.
Patients' perceptions of cancer follow-up care.
More than a third of participants (36%) were not sure which physician was in charge of their cancer follow-up care. As part of follow-up care, 80% of participants wanted counseling from their family physicians, but only 20% received it. About a third of participants (32%) were not satisfied with the follow-up care provided by their family physicians. In contrast, only 18% of participants were dissatisfied with the follow-up care provided by specialists. Older participants were more satisfied with cancer follow-up care than younger participants.
Cancer follow-up care is increasingly becoming part of family physicians' practices. Family physicians need to develop an approach that addresses patients' needs, particularly in the area of emotional support.
Cites: J Natl Cancer Inst. 1999 Oct 20;91(20):1712-410528016
Cites: Aust Fam Physician. 1998 Apr;27(4):266-89581334
Cites: Can Fam Physician. 1995 Aug;41:1314-207580380
Cites: Fam Pract. 1995 Mar;12(1):60-57665044
Cites: J Cancer Educ. 1994 Summer;9(2):67-727917896
Cites: Can Fam Physician. 1994 Jan;40:47-507508776
Cites: Can Fam Physician. 1993 Jan;39:49-578382093
Cites: J Clin Oncol. 2002 Jan 1;20(1):73-8011773156
Cites: Can Fam Physician. 2001 Oct;47:2009-12, 2015-611723595
To describe the number and classes of antihypertensive medications prescribed to patients with type 2 diabetes in community family practices, and to estimate the aggressiveness or "dosage intensity" of prescribing for hypertension in these situations.
Seventeen rural and urban family practices in the Maritime Family Practice Research Network in Nova Scotia, New Brunswick, and Prince Edward Island.
A total of 670 patients with type 2 diabetes, ranging from 25 to 92 years of age.
Number, classes, and combinations of classes of antihypertensive medications prescribed, as well as an index of each medication's dosage intensity.
Almost 80% of patients studied had hypertension. Participants with hypertension were taking an average of 2.5 medications, and 47.6% were taking 3 or more antihypertensive medications, but only 27.1% reached target blood pressure values of less than 130/80 mm Hg. Older patients took more antihypertensive medications, but there were no differences by sex. More than 90% were taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, 66% were taking diuretics, 41% were taking beta-blockers, and 38% were taking calcium channel blockers. We cannot describe the sequence in which antihypertensive medication classes were added, but analysis of patients taking multiple drug classes suggests that most patients were started on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, followed by diuretics, beta-blockers, or calcium channel blockers. The most commonly used medications were prescribed at higher than two-thirds the maximum dose effective for hypertension.
Hypertension is very common among family practice patients with type 2 diabetes; of those patients, few reach target blood pressures. Practice-based strategies to increase dosing and number of medications prescribed might be required.
To identify the genetic defect in a Hutterite population from northern Alberta with Usher syndrome type I.
Complete ophthalmic examinations were conducted on two boys and two girls from two related Hutterite families diagnosed with Usher syndrome type I. DNA from patients and their parents was first evaluated for a mutation in exon 10 of the protocadherin-related 15 (PCDH15) gene (c.1471delG), previously reported in southern Alberta Hutterite patients with Usher syndrome (USH1F). Single nucleotide polymorphic linkage analysis was then used to confirm another locus, and DNA was analyzed with the Usher Chip v4.0 platform.
Severe hearing impairment, unintelligible speech, and retinitis pigmentosa with varying degrees of visual acuity and visual field loss established a clinical diagnosis of Usher syndrome type I. The patients did not carry the exon 10 mutation in the PCDH15 gene; however, with microarray analysis, a previously reported mutation (c.52C>T; p.Q18X) in the myosin VIIA (MYO7A) gene was found in the homozygous state in the affected siblings.
The finding of a MYO7A mutation in two related Hutterite families from northern Alberta provides evidence of genetic heterogeneity in Hutterites affected by Usher syndrome type I.
Cites: Exp Eye Res. 2000 Aug;71(2):173-8110930322
Cites: Mol Vis. 2010;16:1898-90621031134
Cites: Hum Mol Genet. 2001 Aug 1;10(16):1709-1811487575
As Alberta's population ages over the next 20 years, the number of older adults experiencing age-related blindness or vision loss is likely to at least double. To prevent a crisis in low vision service provision, we need to build upon, and extend, existing partnerships between the CNIB and ophthalmologists, optometrists, government policy makers, and other service providers. Future service models for low vision rehabilitation should also emphasize interventions such as counselling and peer support that enhance quality of life. With thoughtful planning, adequate funding, and involvement of all stakeholders, Alberta has the potential to become a world leader in the field of low vision treatment and rehabilitation.