Centralisation of specialist cancer surgery: an assessment of patient preferences for location of care in the upper South Island of New Zealand.
cancer surgery
centralization
health inequities
patient preferences
surveys and questionnaires
values based medicine
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
revised:
17
07
2023
received:
26
04
2023
accepted:
24
07
2023
medline:
18
9
2023
pubmed:
1
8
2023
entrez:
1
8
2023
Statut:
ppublish
Résumé
A positive association between volume and outcome for certain operations has led to increasing centralization. The latter is associated with a greater travel burden for patients. This study investigated patient preferences for location of care for cancer surgery. Two hundred and one participants were recruited from those who have had recent cancer surgery and from general practice or outpatient clinics in both urban and rural locations in the upper South Island of New Zealand. A questionnaire presented participants with a hypothetical scenario of needing cancer surgery and they were asked to indicate their preference of either a hospital 1 or 5 h away. Scenarios evolved in risk of mortality, complications and need for hospital transfer due to a complication. The majority of participants preferred surgery at the closer hospital when there was a negligible difference in risk. Preference shifted to the distant hospital in a linear relationship as the risk of mortality or complications at the closer hospital increased. Respondents were more likely to prefer the distant hospital from the outset if there was a risk of requiring transfer. The majority of participants preferred surgery at the closer hospital if risks were comparable but chose to travel as the risk increased and to avoid hospital transfer due to a complication. New Zealand's unique geography and population make it impossible to replicate centralization models from other countries. The drive for improved outcomes must take equity and patient values into consideration.
Sections du résumé
BACKGROUND
A positive association between volume and outcome for certain operations has led to increasing centralization. The latter is associated with a greater travel burden for patients. This study investigated patient preferences for location of care for cancer surgery.
METHODS
Two hundred and one participants were recruited from those who have had recent cancer surgery and from general practice or outpatient clinics in both urban and rural locations in the upper South Island of New Zealand. A questionnaire presented participants with a hypothetical scenario of needing cancer surgery and they were asked to indicate their preference of either a hospital 1 or 5 h away. Scenarios evolved in risk of mortality, complications and need for hospital transfer due to a complication.
RESULTS
The majority of participants preferred surgery at the closer hospital when there was a negligible difference in risk. Preference shifted to the distant hospital in a linear relationship as the risk of mortality or complications at the closer hospital increased. Respondents were more likely to prefer the distant hospital from the outset if there was a risk of requiring transfer.
CONCLUSION
The majority of participants preferred surgery at the closer hospital if risks were comparable but chose to travel as the risk increased and to avoid hospital transfer due to a complication. New Zealand's unique geography and population make it impossible to replicate centralization models from other countries. The drive for improved outcomes must take equity and patient values into consideration.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2180-2185Subventions
Organisme : Mackenzie Charitable Foundation
Informations de copyright
© 2023 Royal Australasian College of Surgeons.
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