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

Abstract

Objective: Gynaecological 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 UK on their preferred place of outpatient care for gynaecological malignancies and evaluate alignment with preferences of healthcare professionals (HCP).

Methods: We performed a mixed methods study, including a scoping review, a patient survey and a healthcare practitioner questionnaire. We collected quantitative and qualitative data, performing content analysis to determine current practice and impact on patients.

Results: 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). Fifty-three percent of patients were somewhat or very unhappy to have care colocated 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 underestimated 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.

Conclusion: This study demonstrates the significant impact of place of care on gynaecological oncology patients, which may be underestimated by HCPs.

Keywords: Healthcare quality improvement; Obstetrics and gynecology; Patient Preference; Patient-centred care.

Figure 1

Distribution of patient survey respondent age by age categories.

Figure 2

Preferences of different outpatient care locations for service users. Respondents were asked to rate how happy they would be to be seen in four common care settings for gynecological oncology outpatient investigation and follow-up on a 5-point Likert scale from very unhappy (black) to very happy (light grey). Categorical responses compared with χ² analysis (p<0.0001).

Figure 3

Comparison of patient preferences and healthcare professional (HCP) views on patient preferences for four common care settings for gynaecological oncology outpatient investigation and follow-up on a 5-point Likert scale from very unhappy (black) to very happy (light grey). Patient preferences and HCP views for each setting compared with χ² analysis (see text). Gynae onc, gynaecological oncology; O&G, obstetrics and gynaecology; W&C, women’s and childern's center.