Rethinking continuity in primary care for people with mesothelioma.

Area of Science:

• Oncology
• Public Health
• Healthcare Systems Research

Background:

• Mesothelioma, a terminal illness linked to asbestos exposure, presents significant challenges for continuity of care within the UK's National Health Service (NHS) primary care system.
• Despite difficulties, continuity of care is highly valued by individuals diagnosed with mesothelioma and their support networks.

Purpose of the Study:

• To investigate the experiences of continuity in primary care for individuals with mesothelioma, their close persons, and healthcare professionals (HCPs).
• To explore the mechanisms facilitating or hindering continuity of care.
• To understand the impact of continuity on healthcare service utilization.

Main Methods:

• Employed realist case studies examining patient journeys through the healthcare system.
• Conducted longitudinal interviews with 9 patients, 8 close persons, and 12 HCPs (totaling 30.8 hours).
• Analyzed data using Context-Mechanism-Outcome configurations to understand underlying processes.

Main Results:

• Identified challenges unique to mesothelioma care.
• Assessed the capacity of patients, close persons, and HCPs to foster continuity.
• Highlighted differences between multidisciplinary team (MDT) approaches and traditional family doctor models, with participants describing the 'NHS primary care system is broken'.

Conclusions:

• Patients report unmet continuity needs due to primary care system inflexibility.
• The healthcare system requires adaptation to accommodate complex, long-term conditions and novel treatments.
• A societal perspective shift is necessary, recognizing shared responsibility within MDTs rather than solely individual family doctors; policy must prioritize continuity alongside access.