Referrals and Decision-Making Considerations Involved in Selecting a Surgeon for Rectal Cancer Treatment in the Midwestern United States.
Referrals and Decision-Making Considerations Involved in Selecting a Surgeon for Rectal Cancer Treatment in the Midwestern United States.
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美国中西部地区选择直肠癌治疗外科医生时的转诊和决策考虑因素。
DOI：
10.1097/dcr.0000000000002257
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发表时间：
2022
影响因子：
3.9
通讯作者：
Charlton,MaryE
中科院分区：
文献类型：
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作者：
DelVecchio,NatalieJ;Gao,Xiang;Weeks,KristinS;Mengeling,MichelleA;Kahl,AmandaR;Gribovskaja-Rupp,Irena;Lynch,CharlesF;Chrischilles,ElizabethA;Charlton,MaryE
背景：尽管有证据表明，在大容量、多学科的癌症中心，直肠癌患者的预后良好，但许多患者在小容量医院接受手术。目的：这项研究旨在检查以前直肠癌患者在选择外科医生时的考虑因素，并评估哪些考虑因素与大容量医院的手术相关。设计：在这项回顾性队列研究中，患者被调查他们在选择癌症手术时考虑了什么。集合：研究数据是通过调查和全州爱荷华州癌症登记获得的。PATIENTS：所有通过注册中心确定的符合条件的II/III期直肠癌患者都被邀请参加。主要观察指标：主要结果是他们接受手术的医院的特征(即国家癌症研究所名称、癌症鉴定委员会和直肠癌手术量)。结果：在417名受访者中，318人(76%)完成了调查。69%的患者根据医生的推荐/推荐来选择外科医生，20%的患者基于外科医生/医院的声誉，11%的患者基于与外科医生的个人关系。根据声誉选择外科医生的参与者在国家癌症研究所指定的(OR 7.5；95%CI，3.8-15.0)或大容量(OR 2.6；限制：这项研究发生在以白人为主的中西部州，这限制了我们评估种族/民族关联的能力。结论：大多数直肠癌患者在选择外科医生时依赖于转诊，与那些考虑声誉的人相比，那些选择外科医生的人不太可能在国家癌症研究所指定的或大容量医院接受手术。需要进一步的研究来确定这些决定因素对临床结果、患者满意度和生活质量的影响。此外，患者应该意识到，依赖医生转诊可能不会导致从他们所在地区最有经验或最全面的护理环境中进行治疗。请参阅https://links.上的视频摘要LWW。COM/DCR/B897。
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 Video Abstract at https://links. lww. com/DCR/B897.