From the Division of Plastic and Reconstructive Surgery, Toronto General Hospital; the Queen's University School of Medicine; the University Health Network; and the Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto.
Plast Reconstr Surg. 2019 Mar;143(3):465e-476e. doi: 10.1097/PRS.0000000000005313.
The purpose of this systematic review was to comprehensively summarize barriers of access to breast reconstruction and evaluate access using the Penchansky and Thomas conceptual framework based on the six dimensions of access to care.
The authors performed a systematic review that focused on (1) breast reconstruction, (2) barriers, and (3) breast cancer. Eight databases (i.e., EMBASE, MEDLINE, PsycINFO, CINHAL, ePub MEDLINE, ProQuest, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials) were searched. English peer-reviewed articles published between 1996 and 2016 were included.
The authors' search retrieved 4282 unique articles. Two independent reviewers screened texts, selecting 99 articles for inclusion. All studies were observational and qualitative in nature. The availability of breast reconstruction was highest in teaching hospitals, private hospitals, and national cancer institutions. Accessibility affected access, with lower likelihood of breast reconstruction in rural geographic locations. Affordability also impacted access; high costs of the procedure or poor reimbursement by insurance companies negatively influenced access to breast reconstruction. Acceptability of the procedure was not universal, with unfavorable physician attitudes toward breast reconstruction and specific patient and tumor characteristics correlating with lower rates of breast reconstruction. Lastly, lack of patient awareness of breast reconstruction reduced the receipt of breast reconstruction.
Using the access-to-care framework by Penchansky and Thomas, the authors found that barriers to breast reconstruction existed in all six domains and interplayed at many levels. The authors' systematic review analyzed this complex relationship and suggested multiprong interventions aimed at targeting breast reconstruction barriers, with the goal of promoting equitable access to breast reconstruction for all breast cancer patients.
本系统评价的目的是全面总结获取乳房重建的障碍，并根据潘钱斯基和托马斯的六个医疗服务获取维度的概念框架来评估获取途径。
作者进行了一项系统评价，重点关注（1）乳房重建，（2）障碍，以及（3）乳腺癌。作者检索了 8 个数据库（即 EMBASE、MEDLINE、PsycINFO、CINHAL、ePub MEDLINE、ProQuest、Cochrane 系统评价数据库和 Cochrane 对照试验中心注册库）。纳入的文献发表于 1996 年至 2016 年之间的英语同行评审文章。
作者的搜索共检索到 4282 篇独特的文章。两名独立的审查员筛选文本，选择了 99 篇文章进行纳入。所有研究均为观察性和定性研究。在教学医院、私立医院和国家癌症机构，乳房重建的可用性最高。可及性影响了获取途径，农村地区的乳房重建的可能性较低。可负担性也影响了获取途径；手术费用高或保险公司报销不佳会对乳房重建的获取产生负面影响。该手术的可接受性并非普遍存在，医生对乳房重建的态度不利，以及特定的患者和肿瘤特征与较低的乳房重建率相关。最后，患者对乳房重建的认识不足会降低接受乳房重建的机会。
作者使用潘钱斯基和托马斯的医疗服务获取框架发现，乳房重建的障碍存在于所有六个领域，并在多个层面相互作用。作者的系统评价分析了这种复杂的关系，并提出了多管齐下的干预措施，旨在针对乳房重建障碍，目标是为所有乳腺癌患者提供公平获取乳房重建的机会。
