[Continuity of cancer care in Quebec: beyond the symptoms].

OBJECTIVE Serious problems in the continuity of medical care provided to cancer patients are a frequent occurrence; the source of these problems is not well understood. The purpose of this research is to determine how these problems arise and how they are perpetuated.

DESIGN Qualitative descriptive study based on Anthony Giddens's theory of structuration.

SETTING Four teaching hospitals in the Quebec City region.

PARTICIPANTS Cancer patients (n = 62), family physicians (n = 14), and oncology specialists (n = 13).

METHOD Individual interviews were conducted with breast cancer and lung cancer patients. Their medical files were examined so that they could be ranked according to the stage of their disease. We also conducted individual interviews with a sampling of the patients' family physicians and oncology specialists at the hospitals participating in the study. An analysis of the content of the interviews was performed following the principles of grounded theory.

MAIN FINDINGS When conditions arise that are likely to lead to problems in the continuity of medical care, patients and physicians often try to compensate. Health care providers employ regulation strategies and patients and their families employ substitution strategies. Although these strategies generally get results, they constitute one-time actions by the physician or patient to circumvent a problem. And because they do not address the problem across the system, the source of the problem does not change.

CONCLUSION One of the unintentional consequences of the strategies used by clinicians and patients is the masking of the real issues involved in continuity of care; these strategies actually get in the way of in-depth changes based on the needs of the health care system as a whole.