Objectives/purpose: Oesophageal cancer (OC) surgery is high risk, and centralisation of surgical services to high-volume centres has been shown to improve outcomes. In many parts of the World OC surgery has been formally centralised, but not Australia. Patients, however, might perceive centralisation differently to clinicians and be willing to trade-off benefits for treatment closer to home. This study determined how preferences influence choices for surgery for OC.
Sample and setting: A discrete choice experiment (DCE) was undertaken to evaluate the impact of five attributes on preferences for local vs centralised care for oesophageal cancer in Flinders Medical Centre, South Australia.
Procedures: Metropolitan and rural/remote respondents were recruited, patients with Barrett’s oesophagus under surveillance, OC survivors, clinicians, and the general population. Data was analysed using the framework of random utility theory using conditional logit and multinomial logit models. To determine preference changes vs attributes, reference scenarios were set for centralised (distance = 400km, mortality = 3%, LOS = 11-20 days, cost = $1-$1000, survival = 40%) and localised services (<10km, 8%, 20days, $0, 30%).
Results: 295 individuals completed the DCE. Preferences were identified for travel distance <10km (except OC survivors), perioperative mortality <3% (except general population), hospital stay <11 days, out-of-pocket costs <$1000, and 5-year survival >40% (clinicians and general population). Preferences were not influenced by the location of respondents. A centralised service was preferred across all attributes for all respondents, except the general population which preferred localised services if costs were $1001-$5000 (64%). The general population preferred a localised service if the mortality risk was 3% (51%) and 5-year survival was 40% (57%).
Conclusions: Patient and clinician perspectives’ support centralisation of OC services which deliver better outcomes. However, out-of-pocket costs are identified as potential barriers to delivery, and to overcome this support is needed for remotely located patients.