New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Surgery, New York, NY.
Weill Cornell Medicine, Department of Healthcare Policy and Research, New York, NY.
Ann Surg. 2019 Jan;269(1):73-78. doi: 10.1097/SLA.0000000000002556.
To describe public willingness to participate in regionalized surgical care for cancer.
Improved outcomes at high-volume centers following complex surgery have driven a push to regionalize surgical care. Patient attitudes toward regionalization are not well described.
As part of the Cornell National Social Survey, a cross-sectional telephone survey was performed. Participants were asked about their willingness to seek regionalized care in a hypothetical scenario requiring surgery. Their responses were compared with demographic characteristics. A geospatial analysis of hospital proximity was performed, as well as a qualitative analysis of barriers to regionalization.
Cooperation rate was 48.1% with 1000 total respondents. They were an average of 50 years old (range 18 to 100 years) and 48.9% female. About 49.6% were unwilling to travel 5 hours or more to seek regionalized care for improved survival. Age >70 years [odds ratio (OR) 0.34, 95% confidence interval (95% CI) 0.19-0.60] and perceived distance to a center >30 minutes (OR 0.60, 95% CI 0.41-0.86) were associated with decreased willingness to seek regionalized care, while high income (OR 2.09, 95% CI 1.39-3.16) was associated with increased willingness. Proximity to a major center was not associated with willingness to travel (OR 0.92, 95% CI 0.67-1.22). Major perceived barriers to regionalization were transportation, life disruption, social support, socioeconomic resources, poor health, and remoteness.
Americans are divided on whether the potential for improved survival with regionalization is worth the additional travel effort. Older age and lower income are associated with reduced willingness to seek regionalized care. Multiple barriers to regionalization exist, including a lack of knowledge of the location major centers.
描述公众对参与癌症区域化外科治疗的意愿。
复杂手术后在高容量中心取得的改善结果推动了外科治疗的区域化。患者对区域化的态度尚未得到很好的描述。
作为康奈尔国家社会调查的一部分，进行了一项横断面电话调查。参与者被要求在需要手术的假设情况下，对他们是否愿意寻求区域化治疗进行回答。他们的回答与人口统计学特征进行了比较。对医院接近度进行了地理空间分析，并对区域化的障碍进行了定性分析。
合作率为 48.1%，共有 1000 名受访者。他们的平均年龄为 50 岁（范围为 18 至 100 岁），其中 48.9%为女性。约 49.6%的人不愿意旅行 5 小时或更长时间去寻求区域化治疗以提高生存率。年龄 >70 岁[优势比（OR）0.34，95%置信区间（95%CI）0.19-0.60]和感觉距离中心 >30 分钟[OR 0.60，95%CI 0.41-0.86]与降低寻求区域化治疗的意愿相关，而高收入[OR 2.09，95%CI 1.39-3.16]与增加意愿相关。靠近主要中心与旅行意愿无关[OR 0.92，95%CI 0.67-1.22]。区域化的主要感知障碍包括交通、生活中断、社会支持、社会经济资源、健康状况不佳和偏远地区。
美国人对区域化是否能提高生存率以值得付出额外的旅行努力存在分歧。年龄较大和收入较低与降低寻求区域化治疗的意愿相关。区域化存在多种障碍，包括对主要中心位置缺乏了解。
