The location of surgical care for rural patients with rectal cancer: patterns of treatment and patient perspectives
The location of surgical care for rural patients with rectal cancer: patterns of treatment and patient perspectives
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DOI：
10.1503/cjs.002514
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发表时间：
2014-12-01
影响因子：
2.5
通讯作者：
Park, Jason
中科院分区：
文献类型：
--
作者：
Nostedt, Michelle C.;McKay, Andrew M.;Park, Jason
背景：癌症患者接受手术治疗的地方对政策和计划以及患者的满意度和结果有影响。我们进行了一项以人群为基础的分析，在直肠癌患者接受手术和定性分析直肠癌患者的观点上的位置的外科care.Methods：我们回顾了马尼托巴癌症登记处的数据，2004年和2006年之间诊断为结直肠癌（CRC）的患者。我们采访了农村直肠癌患者，了解他们在决定治疗地点时的偏好和考虑因素。访谈数据进行了分析，采用扎根理论approach.Results：从2004年至2006年，2086例患者接受了诊断CRC在马尼托巴（结肠：1578，直肠：508）。在农村患者（n = 907）中，直肠癌患者比结肠癌患者更有可能在城市中心接受手术（46.5% vs. 28.8%，p < 0.001）。20例农村直肠癌患者参加了访谈。我们从访谈资料中找出三大主题：决策者、治疗因素和个人因素。参与者描述了不同的输入到转诊决策，他们往往没有意识到关于治疗地点的选择。治疗因素，包括外科医生因素和医院因素，在考虑治疗位置时很重要。个人因素，包括旅行，支持，住宿，财务和就业，也影响了参与者的治疗experiences.Conclusion：相当大比例的农村直肠癌患者在城市中心接受手术。原因很复杂，只是部分与患者的选择有关。需要进一步的研究，以更好地了解癌症系统在地理上分散的人群中的访问，并支持癌症患者通过决策和治疗过程。
Background: Where cancer patients receive surgical care has implications on policy and planning and on patients' satisfaction and outcomes. We conducted a population-based analysis of where rectal cancer patients undergo surgery and a qualitative analysis of rectal cancer patients' perspectives on location of surgical care.Methods: We reviewed Manitoba Cancer Registry data on patients with colorectal cancer (CRC) diagnosed between 2004 and 2006. We interviewed rural patients with rectal cancer regarding their preferences and the factors they considered when deciding on treatment location. Interview data were analyzed using a grounded theory approach.Results: From 2004 to 2006, 2086 patients received diagnoses of CRC in Manitoba (colon: 1578, rectal: 508). Among rural patients (n = 907), those with rectal cancer were more likely to undergo surgery at an urban centre than those with colon cancer (46.5% v. 28.8%, p < 0.001). Twenty rural patients with rectal cancer participated in interviews. We identified 3 major themes from the interview data: the decision-maker, treatment factors and personal factors. Participants described varying input into referral decisions, and often they did not perceive a choice regarding treatment location. Treatment factors, including surgeon factors and hospital factors, were important when considering treatment location. Personal factors, including travel, support, accommodation, finances and employment, also affected participants' treatment experiences.Conclusion: A substantial proportion of rural patients with rectal cancer undergo surgery at urban centres. The reasons are complex and only partly related to patient choice. Further studies are required to better understand cancer system access in geographically dispersed populations and to support cancer patients through the decision-making and treatment processes.