Provider Viewpoints in the Management and Referral of Rectal Cancer

Xiang Gao; Kristin S Weeks; Irena Gribovskaja-Rupp; Imran Hassan; Marcia M Ward; Mary E Charlton

doi:10.1016/j.jss.2020.08.073

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Provider Viewpoints in the Management and Referral of Rectal Cancer

Journal article

Peer reviewed

Provider Viewpoints in the Management and Referral of Rectal Cancer

Xiang Gao, Kristin S Weeks, Irena Gribovskaja-Rupp, Imran Hassan, Marcia M Ward and Mary E Charlton

The Journal of surgical research, Vol.258, pp.370-380

02/2021

DOI: 10.1016/j.jss.2020.08.073

PMCID: PMC7850858

PMID: 33051062

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https://www.ncbi.nlm.nih.gov/pmc/articles/7850858View

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Abstract

Patients with rectal cancer treated at specialized or high-volume hospitals have better outcomes, but a minority of these patients are treated there. Physician recommendations are important considerations for patients with rectal cancer when making treatment decisions, yet little is known about the factors that affect these physician referral patterns. Semistructured telephone interviews were conducted in 2018-2019 with Iowa gastroenterologists (GIs) and general surgeons (GSs) who performed colonoscopies in a community setting. A thematic approach was used to analyze and code qualitative data. We interviewed 10 GIs and 6 GSs with self-reported averages of 15.5 y in practice, 1100 endoscopic procedures annually, and 6 rectal cancer diagnoses annually. Physicians believed surgeon experience and colorectal specialization were directly related to positive outcomes in rectal cancer resections. Most GSs performed resections on patients they diagnosed and typically only referred patients to colorectal surgeons (CRS) in complex cases. Conversely, GIs generally referred to CRS in all cases. Adhering to existing referral patterns due to the pressure of health care networks was a salient theme for both GIs and GSs. While respondents believe that high volume/specialization is related to improved surgical outcomes, referral recommendations are heavily influenced by existing referral networks. Referral practices also differ by diagnosing specialty and suggest rural patients may be less likely to be referred to a CRS because more GSs perform colonoscopies in rural areas and tend to keep patients for resection. System-level interventions that target referral networks may improve rectal cancer outcomes at the population level.

Physician interview

Qualitative research

Rectal cancer

Referral patterns

Details

Title: Subtitle: Provider Viewpoints in the Management and Referral of Rectal Cancer
Creators: Xiang Gao - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
Kristin S Weeks - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
Irena Gribovskaja-Rupp - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
Imran Hassan - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
Marcia M Ward - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
Mary E Charlton - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
Resource Type: Journal article
Publication Details: The Journal of surgical research, Vol.258, pp.370-380
DOI: 10.1016/j.jss.2020.08.073
PMID: 33051062
PMCID: PMC7850858
NLM abbreviation: J Surg Res
ISSN: 0022-4804
eISSN: 1095-8673
Publisher: Elsevier Inc
Grant note: DOI: 10.13039/100000002, name: National Institutes of Health; DOI: 10.13039/100000054, name: National Cancer Institute
Language: English
Date published: 02/2021
Academic Unit: Health Management and Policy; Epidemiology; Surgery
Record Identifier: 9984214675102771

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