Rethinking continuity in general practice for people with incurable illness:

Background People with terminal diagnoses often derive substantial benefit from continuity of care, a core function of primary care that is also central to high-quality palliative care. Malignant mesothelioma is an incurable cancer caused by asbestos exposure, yet little research has examined how individuals with this condition experience continuity within general practice or how primary care contributes to their palliative needs. Aim Using malignant mesothelioma as a lens, this study explored how people living with, or caring for those with, this condition experience continuity in UK general practice, and examined the work required to navigate the healthcare system during a life-limiting illness. Methods Longitudinal qualitative interviews were conducted with patients, close persons, and healthcare professionals, generating case studies analysed using reflexive thematic analysis and the Candidacy Framework. Five individuals contributed in a patient and public involvement capacity. Findings: Fifty-four interviews formed nine case studies centred on individual patients. Three themes emerged: (1) people with mesothelioma benefit from the generalist, relationship-based care provided by GPs, which often functions as a form of primary palliative care; (2) patients experience distressing uncertainty when navigating a fragmented healthcare system, highlighting gaps in coordination between primary and specialist palliative services; and (3) continuity should be reframed as essential to supporting people with incurable illness, rather than an optional enhancement. Conclusion Participants described the intense burden of living with an incurable disease and emphasised that feeling expected, known, and supported within primary care can reduce suffering. These findings underscore the importance of continuity as a mechanism that bridges primary and palliative care, offering relational, informational, and management support across the illness trajectory. Although focused on mesothelioma in the UK, the implications extend to other populations with serious or rare conditions internationally, reinforcing the need for integrated, patient-centred models of care.