A mixed methods study of attitudes on location of gynaecological oncology outpatient care: a patient and healthcare professional questionnaire

Abstract

AbstractObjectiveGynaecological oncology place of care is often based on evolution of services, along historical professional boundaries, rather than user needs or preferences. We aimed to assess existing evidence, gather views of patients in the United Kingdom (UK) on their preferred place of outpatient care for gynaecological malignancies and evaluate alignment with preferences of healthcare professionals.MethodsWe performed a mixed methods study, including a scoping review, a patient survey, and a health care practitioner questionnaire. We collected quantitative and qualitative data, performing content analysis to determine current practice and impact on patients.ResultsWe performed a mixed methods study, using a scoping review of the literature, patient survey and a healthcare practitioner (HCP) questionnaire, collecting quantitative and qualitative data. No studies were identified in our scoping review. We received responses from 159 patients and 54 gynaecological oncology HCPs. There was a strong preference for a dedicated gynaecological oncology setting (89% somewhat or very happy) (P<0.0001). 53% of patients were somewhat or very unhappy to have care co-located with general obstetrics and gynaecology services. Specifically, two key themes were identified through content analysis of qualitative data from patients: “environment and getting this right is vital”; and “our cancer should be the priority”. HCPs un-der-estimated the strong patient-preference to be seen in dedicated units. Of those who see patients within general obstetrics and gynaecology, only 50% said patients were seen at separate times/locations from obstetric patients.ConclusionThis study demonstrates the significant impact of place of care on gynaecological oncology patients, which may be underestimated by HCPs.Key messagesWhat is already known on this topicStudies have shown that design of healthcare environment can significantly affect patient care, but have focussed on environmental factors, rather than co-location of services.What this study addsGynaecological oncology patients indicated that co-location of clinics with general obstetrics and gynaecology was psychologically distressing or inappropriate, as they were at a different point in their life journey.Patients have a strong preference for their outpatient care to be provided in a dedicated gynaecologic oncology setting, away from women and children’s services.However, gynaecologic oncology services were frequently co-located with general obstetrics and gynaecology services, reflecting evolution of the subspeciality and service development, rather than patient need.How this study might affect research, practice or policyIt is important to advocate for gynaecological oncology patients, to ensure that healthcare service infrastructure is designed around patient need, not historical professional boundaries.