Surgeon-Level Variation in Patients’ Appraisals of Their Breast Cancer Treatment Experiences
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Background and Purpose
While variation in breast cancer quality indicators has been studied, to date there have been no studies examining the degree of surgeon-level variation in patient-reported outcomes. The purpose of this study is to examine surgeon-level variation in patient appraisals of their breast cancer care experiences.
Survey responses and clinical data from breast cancer patients reported to Detroit and Los Angeles Surveillance, Epidemiology and End Results registries from 6/2005 to 2/2007 were merged with attending surgeon surveys (1,780 patients, 291 surgeons). Primary outcomes were patient reports of access to care, care coordination, and decision satisfaction. Random-effects models examined variation due to individual surgeons for these three outcomes.
Mean values on each patient-reported outcome scale were high. The amount of variation attributable to individual surgeons in the unconditional models was low to modest: 5.4 % for access to care, 3.3 % for care coordination, and 7.5 % for decision satisfaction. Few factors were independently associated with patient reports of better access to or coordination of care, but less-acculturated Latina patients had lower decision satisfaction.
Patients reported generally positive experiences with their breast cancer treatment, though we found disparities in decision satisfaction. Individual surgeons did not substantively explain the variation in any of the patient-reported outcomes.
KeywordsBreast Cancer Breast Cancer Treatment Care Coordination Breast Cancer Specialization Decision Satisfaction
Funding for this research comes from R01CA109696 and R01CA08870 to the University of Michigan.
Conflict of interest
- 1.Institute of Medicine, Commission on life Sciences National Research Council. Ensuring quality cancer care. National Academy Press: Washington DC; 1999.Google Scholar
- 11.Hershman DL, Buone D, McBride RB, Tsai WY, Neugut Al. Influence of private practice setting and physician characteristics on the use of breast cancer adjuvant chemotherapy for elderly women. Cancer. 2009;115(17):3848–57.Google Scholar
- 12.Hershman DL, Buone D, Jacobson JS, McBride RB, Tsai WY, Joseph KA, Neugut Al. Surgeon characteristics and use of breast conservation surgery in women with early stage breast cancer. Ann. Surg. 2009;249(5):828–33.Google Scholar
- 14.Spinks T, Albright HW, Feely R, et al. Ensuring quality cancer care: a follow up review of the Institute of Medicine’s 10 recommendation for improving the quality of cancer care in America. Cancer. 2011. doi: 10.1002/cncr.26536.
- 23.Word D. Perkins JR. Building a Spanish Surname List for the 1990’s—a new approach to an old problem. U.S. Census Bureau, Technical Working Paper No. 13. 1996.Google Scholar
- 24.Dillman DA, Smyth DA, Christian LM. Internet, mail and mixed-mode surveys: the tailored design method. Hoboken, NJ: Wiley; 2009.Google Scholar
- 25.Anema MG, Brown BE. Increasing survey responses using the total design method. J Continuing Educ Nurs. 1995;26(3):109–4.Google Scholar
- 28.Snijders TAB, Boster RJ. Multilevel Analysis. Thousand Oaks, CA: Sage; 1999.Google Scholar