Increasing access to breast reconstruction for women living in underserved non-metropolitan areas of Australia
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The potential quality of life benefits of breast reconstruction (BR) for women who have undergone mastectomy for breast cancer have long been recognised. While many women will not want to have BR, international best-practice guidance mandates that all should be given the choice. The aim of this article is to highlight potential policies to support patients’ informed discussion of BR options and to improve access to BR for women living in underserved locations.
Ninety semi-structured interviews were conducted from May 2015 to May 2017 with a convenience sample of 31 breast reconstructive surgeons, 37 breast cancer health professionals and a purposive sample of 22 women who underwent mastectomy as part of their breast cancer treatment. Breast, plastic reconstructive surgeons and health professionals based in major cities also provided information about how they cared for patients from more remote areas.
Analysis of interview data revealed a range of barriers that were grouped into four major categories describing issues for women living outside major cities: population characteristics associated with lower socioeconomic status; locational barriers including limited health services resources and distance; administrative barriers such as hospital policies and inadequate support for women who need to travel; and surgical workforce recruitment barriers.
Suggestions for potential solutions included the following: greater geographical centralisation of BR services within major cities; the creation of designated breast centres with minimum caseload requirements similar to the UK’s system; and a buddy system, whereby smaller hospitals network with multidisciplinary teams based in larger hospitals.
KeywordsBreast cancer Breast reconstruction Access Patient preferences Rural and remote Australia
A Consumer Advisory Panel (CAP) of six women with breast cancer, including an officially appointed representative from Breast Cancer Network Australia (BCNA), provided input into draft questionnaires and participant information to be sent to other women with breast cancer, breast care nurses and breast surgeons. We are grateful for their assistance, as well as to the participants in this project.
Improving Breast Reconstruction Equity of Access through Stakeholder consultation and Translation into policy and practice (I-BREAST) study. Funded through Friends of the Mater, North Sydney. 2014–2019. This project is registered with the Australian New Zealand Clinical Trials Registry. Registration No: 12616000188437 [www.anzctr.org.au/].
Compliance with ethical standards
Ethics approval was obtained from the Human Research Ethics Committee (HREC) of St Vincent’s & Mater Health, Sydney, Australia, in April 2015 (14/181).
Conflict of interest
KF’s salary is funded by The Friends of the Mater Foundation, Sydney, Australia. The Friends of the Mater Foundation have had no influence on the conduct of this project or the preparation of this article. All authors declare they have no conflicts of interest. KF has full control of all primary data. This data has not been deposited into a public repository to protect the anonymity of interview respondents. The journal may review de-identified data if requested.
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