Bergin R, Emery J, Bollard R, White V
Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Vic., Australia.
Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Vic., Australia.
Eur J Cancer Care (Engl). 2017 Nov;26(6). doi: 10.1111/ecc.12646. Epub 2017 Feb 1.
Modern healthcare systems promote patient choice of cancer treatment provider, but little is known about how place of residence influences decision-making. This research explored how rural and urban patients with breast or colorectal cancer experience choice of cancer treatment provider in Victoria, Australia. Realist thematic analysis of 43 semi-structured telephone interviews identified little active participation in decision-making regardless of area of residence or cancer diagnosis. Perceptions of choice were impacted by urgency for treatment, insurance status and access to providers, a key issue for rural patients. All patients wanted high quality care, but needed to trust health professional's recommendations. Rural patients experienced more complex decision-making, balancing a range of social factors with perceptions about quality of accessible care. Further research into variation in quality of care and complex cancer pathways for rural and urban cancer patients is warranted to inform choices and enhance patient-centred care.
现代医疗保健系统提倡患者选择癌症治疗提供者，但对于居住地如何影响决策制定却知之甚少。本研究探讨了澳大利亚维多利亚州农村和城市的乳腺癌或结直肠癌患者在选择癌症治疗提供者方面的体验。对43次半结构化电话访谈进行的现实主义主题分析发现，无论居住地区或癌症诊断如何，患者在决策制定中的积极参与度都很低。对选择的认知受到治疗紧迫性、保险状况和获得提供者服务的影响，这是农村患者的一个关键问题。所有患者都希望获得高质量的护理，但需要信任医疗专业人员的建议。农村患者经历了更复杂的决策过程，需要在一系列社会因素与对可获得护理质量的认知之间取得平衡。有必要对农村和城市癌症患者护理质量的差异以及复杂的癌症治疗路径进行进一步研究，以为选择提供信息并加强以患者为中心的护理。
