Investigators have found that involving patients as partners in the treatment decision-making process may be a critical aspect of patient-centered care, according to a recent study published by Aggarwal et al in Cancer.
Study Methods and Results
In the study, the investigators used 2016 to 2018 National Health Service data to examine choices that female patients with breast cancer made when considering where to undergo cancer-related procedures—including breast-conserving surgery and mastectomy—and assess how policies offering such choices might affect health-care inequities.
The investigators discovered that 32.7% (n = 22,622/69,153) of the patients undergoing breast-conserving surgery and 30.5% (n = 7,179/23,536) of the patients undergoing mastectomy chose to bypass their nearest hospital to receive surgery at a health-care facility farther away from their homes. They noted that the patients who were younger, had no comorbidities, were of White ethnic background, or lived in rural areas were more likely to travel to more distant hospitals.
The patients involved in the study were more likely to be treated at hospitals classified as specialist breast reconstruction centers even if they personally were not undergoing postsurgical breast reconstruction. Further, the patients who underwent mastectomy and immediate breast reconstruction were more likely to travel to hospitals that had surgeons with a strong media reputation for breast cancer surgery and were less likely to travel to hospitals with shorter surgical waiting times. The investigators revealed that the patients did not appear to make choices based on the hospitals’ research activity, quality rating, breast reoperation rates, or status as multidisciplinary cancer centers.
Conclusions
The investigators suggested that that this separation—involving older patients, those with comorbidities, and those of ethnic minority backgrounds receiving cancer care at their local hospitals whereas other patients traveled to receive care at further hospitals and specialist centers—could drive inequities in access to quality cancer care.
“As marginalized groups already face barriers to high-quality care, it is important for policymakers to consider measures that mitigate against the risks of increasing inequalities in access and outcomes by, for example, providing free transport, accommodation, or even protection against loss of income,” emphasized co–study author Lu Han, PhD, of the London School of Hygiene & Tropical Medicine. “Moreover, patients prefer to access information on the quality of breast cancer care [from] the hospitals in their region at the start of the management pathway when a diagnosis is sought. Such information should be easy to understand and presented in a format that can support the tradeoffs that patients have to make,” she concluded.
Disclosure: For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.
