This study showed that there are still challenges to be overcome in getting patients to accept that some of their cancer surveillance is being performed in the community. The participants felt comfortable with the current monitoring arrangements and did not want to see another doctor. As the current literature suggests, consistency and standard of follow-up care are valued by cancer patients [7, 8]. Patients who have developed a relationship with their surgeons during their cancer treatment would feel comfortable entrusting their health to these specialists . It was interesting that employed participants were more willing to wait for their advice, even though they had to take time off. More can be done to uncover issues and barriers faced by working patients so that the economic costs of time off can be minimized.
Another area to examine is the participants’ willingness to be seen by a specialized HCP for surveillance consultations. This may be due to patient exposure to the Teamlet model of care in Singapore’s subsidized primary care facilities (polyclinics). Teamlets consist of doctors, nurses and care coordinators and are responsible for the care of a fixed group of patients with chronic diseases . The patient can be cared for by any of the HCPs on the team and the patients are aware that their plan of care would have been discussed within the team before being looked after to ensure continuity of care. Participants may therefore be content with seeking out a specialized HCP for familiarity with this system.
Participants were divided about having surveillance phlebotomy procedures performed outside of the specialty clinic. One reason may be that cancer patients in specialist clinics receive heavily subsidized care. Therefore, some participants feared that bloodletting costs would increase drastically if performed in polyclinics or at their homes. Participants were also concerned about longer wait times as they viewed these services as less efficient. Some participants preferred the one-stop nature of their visit to the specialist clinic, where the bloodletting operation was followed by a doctor’s consultation. While home phlebotomy theoretically allows a patient to wait in the comfort of their own home, it can come with an uncertain time frame.
Another aspect that may have been overlooked is the social aspect that these health visits entail, especially for unemployed patients. They might treat the visit to the specialty clinic as a social routine, much like visiting old friends .
Most participants did not like the idea of replacing personal advice with telemedicine via video conference. Some unemployed participants were unwilling to learn skills for telemedicine consultations, possibly due to the perceived high level of effort required to achieve digital literacy . Whether the relationship level is maintained during a telemedical consultation remains undetermined. However, the employed participants were more likely to agree to the use of telemedicine. Due to your professional obligations, telemedical advice is a good alternative to visiting a doctor without having to take a break from work.
The results of this exploratory study highlight the different perspectives between healthcare providers, policy makers and patients. While shifting the tertiary clinical burden to the outpatient and primary care settings makes economic and logistical sense, it may not be as well accepted by patients . A clearer understanding of care integration in community-based surveillance care, which emphasizes the contribution of both specialists and primary care professionals, could help patients to better accept community-based surveillance . An in-depth assessment is needed to identify barriers and issues patients face, such as: B. Relationship, adoption of technology, healthcare costs and reputation of primary care facilities. Despite our limited sample size, this study allowed us to examine the views of patients with the least intensive postoperative follow-up plans and provided a snapshot of patient concerns that the healthcare system would need to address in referral for cancer surveillance consultations in community and primary care settings. Addressing these concerns can help increase patient acceptance of community monitoring and thus the opportunity to proceed with a continuum of care in which stable patients can be monitored in primary care and in the community rather than in the tertiary hospital.