Health System Barriers to the Discussion of Breast Reconstruction Options in Australia: Improving Access Through Appropriate Referral

Kathy Flitcroft (1), Meagan Brennan (2), Andrew Spillane (3)
(1) he University of Sydney, Northern Clinical School, Sydney, Australia AND Breast & Surgical Oncology, The Poche Centre, Sydney, Australia, Australia,
(2) he University of Sydney, Northern Clinical School, Sydney, Australia AND The University of Notre Dame, Sydney,128-140 Broadway Chippendale NSW 2007, Australia AND Westmead Hospital, Hawkesbury Rd Westmead NSW 2145, Australia, Australia,
(3) he University of Sydney, Northern Clinical School, Sydney, Australia AND Breast & Surgical Oncology, The Poche Centre, Sydney, Australia, Australia
https://doi.org/10.32768/abc.202073168-177

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Issue
Vol 7, No 4: November 2020
Submitted
September 2, 2020
Published
November 16, 2020
Keywords:
    Breast reconstruction, Informed choice, Breast cancer, Referral pathways, Health care reform, Patient preferences
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Abstract

Background: This study aimed to document referral-based barriers impeding Australian women's informed decision-making about breast reconstruction (BR) and to propose a designated BR referral pathway to help overcome these barriers.
Methods: Semi-structured, in-depth interviews were conducted with ten women previously treated for breast cancer, 9 breast and reconstructive surgeons and 6 health professionals [n=25] who had identified problems with referrals for BR.
Results: Referral-based barriers to BR discussion were identified at three different levels: from a public or private screening center to a General Practitioner (GP) or breast surgeon; from a GP to a breast surgeon; and from one breast surgeon (without BR skills) to another breast or plastic reconstructive surgeon (with BR skills). A lack of designated referral pathways has meant that clinically eligible women who are interested in considering immediate BR have been denied this opportunity.
Conclusions: Streamlining referral processes, along with patient and clinician education, would help to ensure that women are at least seen by the most appropriate clinicians to discuss BR options and to maximise their opportunity for BR should they choose that option. Designated referral pathways could also be useful in ensuring that preference-sensitive treatment decisions are facilitated in settings with varying degrees of resources and in a range of clinical conditions.

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Authors

Kathy Flitcroft
he University of Sydney, Northern Clinical School, Sydney, Australia AND Breast & Surgical Oncology, The Poche Centre, Sydney, Australia
kathy.flitcroft@melanoma.org.au (Primary Contact)
Meagan Brennan
he University of Sydney, Northern Clinical School, Sydney, Australia AND The University of Notre Dame, Sydney,128-140 Broadway Chippendale NSW 2007, Australia AND Westmead Hospital, Hawkesbury Rd Westmead NSW 2145, Australia
https://orcid.org/0000-0002-3281-7643
Andrew Spillane
he University of Sydney, Northern Clinical School, Sydney, Australia AND Breast & Surgical Oncology, The Poche Centre, Sydney, Australia
https://orcid.org/0000-0002-8354-434X
Author Biographies

Kathy Flitcroft, he University of Sydney, Northern Clinical School, Sydney, Australia AND Breast & Surgical Oncology, The Poche Centre, Sydney, Australia

Dr Kathy Flitcroft is a post-doctoral Research Fellow with the Breast & Surgical Oncology team at the Poche Centre in North Sydney. She is an experienced qualitative health and health policy researcher with a PhD in public health, a master’s degree in government, a graduate certificate in health policy, an undergraduate degree in behavioural sciences and registered nurse qualifications. Kathy’s main research interest is the translation of evidence into cancer policy and practice. Kathy is passionate about facilitating informed choice for patients, particularly in relation to options for breast reconstruction, and in providing access to psychosocial support for melanoma patients.

Meagan Brennan, he University of Sydney, Northern Clinical School, Sydney, Australia AND The University of Notre Dame, Sydney,128-140 Broadway Chippendale NSW 2007, Australia AND Westmead Hospital, Hawkesbury Rd Westmead NSW 2145, Australia

Associate Professor Meagan Brennan is a Breast Physician with expertise in the diagnostic work-up of women with breast symptoms. Meagan’s research interests include survivorship care and breast imaging, as well as breast cancer in Aboriginal and Torres Strait Islander women and women from culturally diverse backgrounds. Meagan has been a leader in developing the role of the breast physician in the cancer team and has over 60 peer reviewed publications.  She is a Clinical Associate Professor at Sydney Medical School and also holds a Staff Specialist appointment at Westmead Hospital. She teaches at the University of Sydney and the University of Notre Dame.

Andrew Spillane, he University of Sydney, Northern Clinical School, Sydney, Australia AND Breast & Surgical Oncology, The Poche Centre, Sydney, Australia

Andrew Spillane is Professor of Surgical Oncology at The University of Sydney, Northern Clinical School. He specialises in the surgical and clinical management, as well as translational research, of breast cancer and melanoma. Andrew has over 150 publications and his current research interests investigate issues around quality assurance in surgery, safe introduction of new surgical techniques and promoting clinical trial involvement by surgeons. He is former President of Breast Surgeons of Australia and New Zealand and remains a clinical and research leader in this area. He lectures and teaches students at The University of Sydney Northern Clinical School.

1.
Flitcroft K, Brennan M, Spillane A. Health System Barriers to the Discussion of Breast Reconstruction Options in Australia: Improving Access Through Appropriate Referral. Arch Breast Cancer [Internet]. 2020 Nov. 16 [cited 2024 May 21];:168-77. Available from: https://www.archbreastcancer.com/index.php/abc/article/view/315
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