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Determinants of Rectal Cancer Patients’ Decisions on Where to Receive Surgery: a Qualitative Analysis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Current literature suggests surgeons who perform large volumes of rectal cancer resections achieve superior outcomes, but only about half of rectal cancer resections are performed by high-volume surgeons in comprehensive hospitals. Little is known about the considerations of patients with rectal cancer when deciding where to receive surgery.

Methods

A purposive sample of stage II/III rectal adenocarcinoma survivors diagnosed 2013–2015 were identified through the Iowa Cancer Registry and interviewed by telephone about factors influencing decisions on where to receive rectal cancer surgery.

Results

Fifteen survivors with an average age of 63 were interviewed: 60% were male, 53% resided in non-metropolitan areas, and 60% received surgery at low-volume facilities. Most patients considered surgeon volume and experience to be important determinants of outcomes, but few assessed it. Recommendation from a trusted source, usually a physician, appeared to be a main determinant of where patients received surgery. Patients who chose low-volume centers noted comfort and familiarity as important decision factors.

Conclusion

Most rectal cancer patients in our sample relied on physician referrals to decide where to receive surgery. Interventions facilitating more informed decision-making by patients and referring providers may be warranted.

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Author information

Authors and Affiliations

  1. Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Room S453 CPHB, Iowa City, IA, 52242, USA

    Mary E. Charlton, Elizabeth A. Chrischilles & Charles F. Lynch

  2. Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, IA, USA

    Mary E. Charlton, Lisa Hunter & Charles F. Lynch

  3. Department of Communications, University of Iowa College of Liberal Arts and Sciences, Iowa City, IA, USA

    Ariana F. Shahnazi

  4. Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Irena Gribovskaja-Rupp

  5. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Michele A. Mengeling

  6. Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA, USA

    Marcia M. Ward

Authors
  1. Mary E. Charlton
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  2. Ariana F. Shahnazi
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  4. Lisa Hunter
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  5. Michele A. Mengeling
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  6. Elizabeth A. Chrischilles
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  7. Charles F. Lynch
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  8. Marcia M. Ward
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Contributions

Dr. Charlton was involved in every aspect of the study and developed the initial manuscript draft. Drs. Mengeling, Chrischilles, Lynch and Ward participated in the conception and design of the work. Ms. Shahnazi and Hunter were central to the acquisition and analysis of the data. Drs. Gribovskaja-Rupp, Mengeling, Chrischilles, Lynch and Ward contributed to the interpretation of the data. All authors provided multiple rounds of critical review and revisions, reviewed the final version of the manuscript, and approved it for submission. All authors have agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Mary E. Charlton.

Ethics declarations

This study was approved by the University of Iowa Institutional Review Board.

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Funding

This work was supported by NIH/NCI K07 Cancer Prevention, Control, Behavioral Sciences and Population Sciences Career Development Award: 1K07CA197067 and in part by NIH/NCI contract number HHSN261201300020I.

This work was presented at the ASCO GI Symposium, January 2018, San Francisco, CA.

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Charlton, M.E., Shahnazi, A.F., Gribovskaja-Rupp, I. et al. Determinants of Rectal Cancer Patients’ Decisions on Where to Receive Surgery: a Qualitative Analysis. J Gastrointest Surg 23, 1461–1473 (2019). https://doi.org/10.1007/s11605-018-3830-x

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  • DOI: https://doi.org/10.1007/s11605-018-3830-x

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