Broman Kristy K, Herbey Ivan, Hollenquest Britany, Dykes Elissa, Bhatia Smita, Ivankova Nataliya
Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, AL; Department of Veterans Affairs, Birmingham VA Medical Center, AL.
University of Alabama at Birmingham Heersink School of Medicine, AL.
Surgery. 2025 Apr;180:109002. doi: 10.1016/j.surg.2024.109002. Epub 2024 Dec 26.
Cancer centers are increasingly affiliating with regional hospitals, creating hub-spoke models for care delivery. Patient perspectives on accessing surgical cancer care within these systems are not well understood. The study purpose was to understand patient perceptions of hub-spoke models of care delivery and how they influence decisions regarding where to seek surgical care for cancer.
We conducted semistructured interviews with patients from a rural catchment area who underwent surgery for breast cancer at a hub cancer center or its rural affiliate spoke hospital. We performed collaborative coding using both inductive and deductive coding strategies. Within- and cross-case analyses were performed, emphasizing factors in participants' choice of location for surgery and their impressions of the hub-spoke network affiliation.
There were 18 participants who underwent breast cancer surgery at the hub (n = 8) or spoke (n = 10). Participants had universally favorable impressions of the hub hospital brand while they expressed mixed opinions about the spoke hospital. When choosing a hospital for surgery, participants considered their medical condition, access, and perceived quality. Although some were not influenced by the affiliate relationship (either because they would seek local care regardless or because they preferred to travel to the high-volume hub), for others the affiliate relationship provided excellent synergy, enabling them to access hub-quality care within their own community.
Findings highlight unique patient perspectives that require distinct considerations when designing affiliate network models for surgical cancer care.
癌症中心越来越多地与地区医院建立合作关系，形成了中心-辐条式的医疗服务模式。目前对于患者在这些系统中获得癌症手术治疗的看法尚不清楚。本研究的目的是了解患者对中心-辐条式医疗服务模式的看法，以及这种模式如何影响他们选择癌症手术治疗地点的决策。
我们对来自农村集水区、在中心癌症中心或其农村附属辐条医院接受乳腺癌手术的患者进行了半结构化访谈。我们采用归纳和演绎编码策略进行协作编码。进行了案例内和跨案例分析，重点关注参与者选择手术地点的因素以及他们对中心-辐条网络附属关系的印象。
共有18名参与者在中心医院（n = 8）或辐条医院（n = 10）接受了乳腺癌手术。参与者对中心医院品牌普遍持积极看法，而对辐条医院的看法则褒贬不一。在选择手术医院时，参与者会考虑自身病情、就医便利性和感知质量。虽然有些人不受附属关系的影响（要么是因为他们无论如何都会寻求当地治疗，要么是因为他们更喜欢前往大型中心医院），但对另一些人来说，附属关系提供了出色的协同效应，使他们能够在自己的社区获得中心医院水平的医疗服务。
研究结果突出了患者独特的观点，在设计癌症手术治疗的附属网络模式时需要予以特别考虑。
