Discrete-choice experiment to analyse preferences for centralizing specialist cancer surgery services

Abstract

BackgroundCentralizing specialist cancer surgery services aims to reduce variations in quality of care and improve patient outcomes, but increases travel demands on patients and families. This study aimed to evaluate preferences of patients, health professionals and members of the public for the characteristics associated with centralization.MethodsA discrete‐choice experiment was conducted, using paper and electronic surveys. Participants comprised: former and current patients (at any stage of treatment) with prostate, bladder, kidney or oesophagogastric cancer who previously participated in the National Cancer Patient Experience Survey; health professionals with experience of cancer care (11 types including surgeons, nurses and oncologists); and members of the public. Choice scenarios were based on the following attributes: travel time to hospital, risk of serious complications, risk of death, annual number of operations at the centre, access to a specialist multidisciplinary team (MDT) and specialist surgeon cover after surgery.ResultsResponses were obtained from 444 individuals (206 patients, 111 health professionals and 127 members of the public). The response rate was 52·8 per cent for the patient sample; it was unknown for the other groups as the survey was distributed via multiple overlapping methods. Preferences were particularly influenced by risk of complications, risk of death and access to a specialist MDT. Participants were willing to travel, on average, 75 min longer in order to reduce their risk of complications by 1 per cent, and over 5 h longer to reduce risk of death by 1 per cent. Findings were similar across groups.ConclusionRespondents' preferences in this selected sample were consistent with centralization.

Toward a Consensus on Centralization in Surgery

“…In another study from the UK, patient's preference to be treated in a high-volume center was based on a lower risk of complications and death, and a better access to multidisciplinary teams. 96 In the same study, patients were willing to travel on average 75 minutes longer in order to reduce their risk of complications by 1%, and over 5 hours longer to reduce risk of death by 1%. According to US studies, for many patients, the influence of outcome data on patients' hospital selection might be overestimated.…”

Population-based study of the impact of surgical and adjuvant therapy at the same or a different institution on survival of patients with pancreatic adenocarcinoma

“…Investigations into patient preferences have revealed that patients with cancer are willing to travel to access specialized surgical care and improve their outcome. However, if there is no increased risk of complications or death, patients prefer to be cared for locally, closer to home, as this often allows for reduced patient‐incurred costs and increased social support from family and friends. In the present study, patients who received adjuvant treatment at a different institution from that where they had surgery travelled a mean of 83·8 km more to undergo pancreatic resection, but no extra distance to receive chemotherapy (26·2 and 22·9 km for the 2 chemotherapy groups).…”

“…The study highlights the ability to obtain similar survival for patients by combining surgery for pancreatic adenocarcinoma in specialized centres with decentralized administration of adjuvant chemotherapy, closer to home. This is crucial information for designing patient‐centred and sustainable healthcare delivery strategies and networks of cancer care that support patients to be cared for close to their homes while being offered optimal cancer outcome, along with better social support, enhanced experience and reduced travelling and financial burdens , .…”

“…Whether policy‐mandated or happening naturally, regionalization of surgical care for pancreatic adenocarcinoma to high‐volume centres has become a reality in many healthcare systems. Although patients are willing to travel to high‐volume centres to seek improved outcomes, they also highly value care closer to home when comparable quality of care and outcomes can be provided . As a result, patients may receive surgery and adjuvant chemotherapy at different institutions.…”

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

“…In cancer care, patients were willing to travel 75 min longer to reduce their risk of complications by 1% and over 5 h longer to reduce their risk of mortality by 1%. . The same principle will undoubtedly be true for IBD patients accessing IBD services.…”