Determinants of Rectal Cancer Patients’ Decisions on Where to Receive Surgery: a Qualitative Analysis

Charlton, Mary E.; Shahnazi, Ariana F.; Gribovskaja‐Rupp, Irena; Hunter, Lisa; Mengeling, Michelle A.; Chrischilles, Elizabeth A.; Lynch, Charles F.; Ward, Marcia M.

doi:10.1007/s11605-018-3830-x

Cited by 14 publications

(11 citation statements)

References 33 publications

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“…Despite these difficulties, our participants believed that a hospital volume-outcome relationship exists for TKA. Similarly, in other studies in the USA, participants believed that the number of times a surgeon performs rectal cancer surgery makes a difference to the outcomes [41], and candidates for hip or knee arthroplasty cared about hospital volume when deciding where to have surgery [26]. In Germany, patients ranked 'volume of specified surgical procedures' in 7th place out of 29 quality indicators [42], suggesting that hospital volume was perceived as important for outcome quality.…”

Section: Hospital Volumes and The Hospital Volume-outcome Relationshipmentioning

confidence: 86%

“…Referring physicians, as trusted experts and possible multipliers, could increase both awareness and understanding of information on hospital quality and volumes if they discussed it with their patients. This suggestion is supported by the finding that, in contrast to low volume hospitals, patients with rectal cancer in high volume hospitals received the recommendation for such hospitals from their social networks, such as referring physicians or relatives with medical knowledge [41]. However, older studies show that not all physicians are aware of hospital quality reports (48% of surveyed German physicians in 2010 [59]) and that few use such reports for referral and counselling of patients (approximately 12-20%) [59][60][61][62][63][64].…”

Section: Referring Physiciansmentioning

confidence: 90%

“…In sum, the usage of information regarding hospital quality is low among patients [27,50,52]. Possible reasons may be that patients trust their physicians to refer them to a hospital with expertise or expect the operating surgeons to tell them if the surgery was too complicated to be performed in a low-volume hospital [41] and therefore feel no need for more information [53].…”

Section: Difficulties With Hospital Quality Informationmentioning

confidence: 99%

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Perspective of potential patients on the hospital volume-outcome relationship and the minimum volume threshold for total knee arthroplasty: a qualitative focus group and interview study

Kugler

Santis

Rombey

et al. 2021

BMC Health Serv Res

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Background Total knee arthroplasty (TKA) is performed to treat end-stage knee osteoarthritis. In Germany, a minimum volume threshold of 50 TKAs/hospital/year was implemented to ensure outcome quality. This study, embedded within a systematic review, aimed to investigate the perspectives of potential TKA patients on the hospital volume-outcome relationship for TKA (higher volumes associated with better outcomes). Methods A convenience sample of adults with knee problems and heterogeneous demographic characteristics participated in the study. Qualitative data were collected during a focus group prior to the systematic review (n = 5) and during telephone interviews, in which preliminary results of the systematic review were discussed (n = 16). The data were synthesised using content analysis. Results All participants (n = 21) believed that a hospital volume-outcome relationship exists for TKA while recognising that patient behaviour or the surgeon could also influence outcomes. All participants would be willing to travel longer for better outcomes. Most interviewees would choose a hospital for TKA depending on reputation, recommendations, and service quality. However, some would also choose a hospital based on the results of the systematic review that showed slightly lower mortality/revision rates at higher-volume hospitals. Half of the interviewees supported raising the minimum volume threshold even if this were to increase travel time to receive TKA. Conclusions Potential patients believe that a hospital volume-outcome relationship exists for TKA. Hospital preference is based mainly on subjective factors, although some potential patients would consider scientific evidence when making their choice. Policy makers and physicians should consider the patient perspectives when deciding on minimum volume thresholds or recommending hospitals for TKA, respectively.

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Section: Hospital Volumes and The Hospital Volume-outcome Relationshipmentioning

confidence: 86%

Section: Referring Physiciansmentioning

confidence: 90%

Section: Difficulties With Hospital Quality Informationmentioning

confidence: 99%

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Perspective of potential patients on the hospital volume-outcome relationship and the minimum volume threshold for total knee arthroplasty: a qualitative focus group and interview study

Kugler

Santis

Rombey

et al. 2021

BMC Health Serv Res

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“…Our finding of infrequent referral of patients by individual physicians is consistent with the study of Mandl et al, who showed that collaboration of patient care among all types of providers for outpatient clinic appointments was uncommon [17]. Our focus on the referring physician in the context of the treatment of a brain tumor seems appropriate based on the study of Charlton et al, who demonstrated that most rectal cancer patients relied on the advice of their own physician, and few attempted to assess either surgeon volume or experience in deciding where to seek definitive treatment [18]. Our finding that a substantive number of patients (e.g., from Miami-Dade, Palm Beach, and Broward counties) drove past many other hospitals offering brain surgery or traveled to Miami (e.g., from Collier and Lee counties) rather than to closer hospitals in the opposite direction is consistent with the study of Dexter et al, who showed that absolute distance rather than relative distance was the important travel consideration [19].…”

Section: Discussionmentioning

confidence: 99%

Building a Brain Tumor Practice: Objective Analysis of Referral Patterns and Implications for the Growth of a Subspecialty Surgical Program

Eichberg¹,

Epstein²,

Dexter³

et al. 2020

Cureus

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Introduction Growth of surgical caseload among specialties with a large contribution margin is an important financial objective for hospitals. In this study, we examined the diversity of referral patterns to a neurosurgeon over an eight-year interval and examined practice attributes related to surgical growth. Methods The electronic records of all patients undergoing an intracranial surgical procedure between August 2011 and August 2019 by an academic neurosurgeon were reviewed retrospectively. The Herfindahl-Hirschman index (HHI) was used to assess the distribution of referrals among community physicians who referred such patients; a value of HHI <0.15 indicates diversity. The yearly HHI trend was evaluated using metaregression. Results The neurosurgeon's brain surgery caseload progressively increased on an annual basis from 1.4 to 12.5 cases per week between 2012 and 2018. Among the 1540 cases referred by 1775 different physicians, 78% were from three counties in southeast Florida and 8.1% from two counties in southwest Florida. The HHI declined between 2013 and 2018 by 0.023 per year (0.0046 standard error [SE], p = 0.0073) with the estimated value 0.0063 (0.0014 SE) < 0.15 in 2018 (p < 0.0001). The findings indicate that the base of referring physicians was highly diverse and that growth in caseload was accompanied by significantly less concentration of referrals. Conclusion Surgical growth in the neurosurgeon's practice resulted from a small number of referrals from many physicians, not from many referrals from a small number of physicians. Few physicians referred a sufficient number of patients to warrant attribution of the referral itself to personal knowledge of their patients' eventual outcomes. Rather, factors promoting timely access to patient care appear to have been the driving force for growth.

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“…The survey instrument was designed based on qualitative information collected from individuals diagnosed with rectal cancer in semistructured interviews. [19][20][21] Survey instruments were further vetted and refined based on feedback from colorectal surgeons and survey methodologists. Cognitive testing of the instrument was conducted with 5 individuals diagnosed with rectal cancer who had follow-up appointments for their rectal cancer surgery at a tertiary referral hospital in the month preceding survey implementation.…”

Section: Survey Instrument Designmentioning

confidence: 99%

Referrals and Decision-Making Considerations Involved in Selecting a Surgeon for Rectal Cancer Treatment in the Midwestern United States

Vecchio

Gao

Weeks

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Despite evidence of superior outcomes for rectal cancer at high-volume, multidisciplinary cancer centers, many patients undergo surgery in low-volume hospitals.OBJECTIVE: This study aimed to examine considerations of former patients with rectal cancer when selecting their surgeon and to evaluate which considerations were associated with surgery at high-volume hospitals. DESIGN: In this retrospective cohort study, patients were surveyed about what they considered when selecting a cancer surgeon. SETTINGS: Study data were obtained via survey and the statewide Iowa Cancer Registry. PATIENTS: All eligible individuals diagnosed with invasive stages II/III rectal cancer from 2013 to 2017 identified through the registry were invited to participate. MAIN OUTCOME MEASURES:The primary outcomes were the characteristics of the hospital where they received surgery (ie, National Cancer Institute designation, Commission on Cancer accreditation, and rectal cancer surgery volume).RESULTS: Among respondents, 318 of 417 (76%) completed surveys. Sixty-nine percent of patients selected their surgeon based on their physician's referral/ recommendation, 20% based on surgeon/hospital reputation, and 11% based on personal connections to the surgeon. Participants who chose their surgeon based on reputation had significantly higher odds of surgery at National Cancer Institute-designated (OR 7.5; 95% CI, 3.8-15.0) or high-volume (OR 2.6; 95% CI, 1.2-5.7) hospitals than those who relied on referral.LIMITATIONS: This study took place in a Midwestern state with a predominantly white population, which limited our ability to evaluate racial/ethnic associations.CONCLUSION: Most patients with rectal cancer relied on referrals in selecting their surgeon, and those who did were less likely to receive surgery at a National Cancer Institute-designated or high-volume hospitals compared to those who considered reputation. Future research is needed to determine the impact of these decision factors on clinical outcomes, patient satisfaction, and quality of life. In addition, patients should be aware that relying on physician referral may not result in treatment from the most experienced or comprehensive care setting in their area. See

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Determinants of Rectal Cancer Patients’ Decisions on Where to Receive Surgery: a Qualitative Analysis

Abstract: Most rectal cancer patients in our sample relied on physician referrals to decide where to receive surgery. Interventions facilitating more informed decision-making by patients and referring providers may be warranted.

Cited by 14 publications

References 33 publications

Perspective of potential patients on the hospital volume-outcome relationship and the minimum volume threshold for total knee arthroplasty: a qualitative focus group and interview study

Perspective of potential patients on the hospital volume-outcome relationship and the minimum volume threshold for total knee arthroplasty: a qualitative focus group and interview study

Building a Brain Tumor Practice: Objective Analysis of Referral Patterns and Implications for the Growth of a Subspecialty Surgical Program

Referrals and Decision-Making Considerations Involved in Selecting a Surgeon for Rectal Cancer Treatment in the Midwestern United States

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