Rethinking continuity in general practice for people with incurable illness: a qualitative case study of mesothelioma

Continuity in general practice has clear benefits but is difficult to achieve. Existing research has identified groups of individuals who may especially benefit from continuity, such as those with a terminal condition. Mesothelioma is an incurable disease caused by asbestos exposure and people with this diagnosis derive significant benefit from continuity. However, there is little research exploring continuity in general practice for these individuals.

The aim of this study was to provide detailed understanding of experiences of continuity in UK general practice among people with mesothelioma, their close persons, and their healthcare professionals (HCPs); how they achieve this (or not); and how it affects their healthcare service use.

Qualitative data obtained from longitudinal interviews with people with mesothelioma, their close persons, and their HCPs was used to construct detailed case studies. Reflexive thematic analysis was undertaken. Five individuals participated in a patient and public involvement capacity.

Data from 54 interviews formed nine case studies. Findings are presented in relation to five overarching themes: 1) people with mesothelioma experience unique challenges in achieving continuity; 2) patient/close person capacity to facilitate continuity in general practice; 3) HCP capacity to facilitate continuity in general practice; 4) MDT approach differs from traditional family doctor model; and 5) 'NHS general practice is broken'.

This research deepens understanding of continuity in general practice for people with mesothelioma. Although this study focused on people with mesothelioma in the UK, it is relevant to other international patient populations, particularly those with other rare conditions or palliative care needs.