Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Department of Clinical Oncology, Guy's & St Thomas' NHS Trust, London, UK.
Centre for Social Research in Health, UNSW, Sydney, Australia.
Clin Oncol (R Coll Radiol). 2018 Jul;30(7):e67-e73. doi: 10.1016/j.clon.2018.03.009. Epub 2018 Apr 19.
There is limited evidence about how patients respond to hospital choice policies, the factors that inform and influence patient choices or how relevant these policies are to cancer patients. This study sought to evaluate hospital choice policies from the perspective of men who received treatment for prostate cancer in the English National Health Service.
Semi-structured interviews were undertaken with a purposive sample of 25 men across England. Fourteen men had chosen to receive treatment at a cancer centre other than their nearest. Interviews were recorded and analysed concurrently with data collection.
Men highlight that the geographical configuration of specialist services, the perceived urgency of the condition and the protocolisation of treatment pathways all limit their choice of a specialist treatment centre. Diseases such as cancer appear not to be well suited to the patient choice model, given the lack of hospital-level outcome data. Men instead use proxy measures of quality, leaving them vulnerable to influence by marketing and media reports. Men wishing to consider other treatment centres need to independently collect and appraise complex treatment-related information, which creates socioeconomic inequities in access to treatments. A positive impact of the choice agenda is that it enables patients to 'exit care' not meeting their expectations.
Policy makers have failed to consider the organisational, disease-specific and socio-cognitive factors that influence a patient's ability to choose their cancer treatment provider. Valid comparative hospital-level performance information is required to guide patients' choices, otherwise patients will continue to depend on informal sources, which will not necessarily improve their health care outcomes.
关于患者对医院选择政策的反应、影响患者选择的因素以及这些政策与癌症患者的相关性，证据有限。本研究旨在从在英国国家卫生服务体系中接受前列腺癌治疗的男性的角度评估医院选择政策。
在英格兰，通过目的性抽样，对 25 名男性进行了半结构式访谈。其中 14 人选择在离家较远的癌症中心接受治疗。访谈在数据收集的同时进行记录和分析。
男性强调，专科服务的地理位置配置、疾病的紧迫性感知以及治疗途径的规范化都限制了他们选择专科治疗中心的机会。由于缺乏医院层面的结果数据，癌症等疾病似乎不太适合患者选择模式。男性转而使用质量的替代指标，这使他们容易受到营销和媒体报道的影响。希望考虑其他治疗中心的男性需要独立收集和评估复杂的治疗相关信息，这在获得治疗方面造成了社会经济不平等。选择议程的一个积极影响是，它使患者能够“退出不符合他们期望的治疗”。
政策制定者未能考虑影响患者选择癌症治疗提供者能力的组织、疾病特异性和社会认知因素。需要有有效的比较医院层面的绩效信息来指导患者的选择，否则患者将继续依赖非正规信息，这不一定会改善他们的医疗保健结果。
