Motivators, Barriers, and Facilitators to Traveling to the Safest Hospitals in the United States for Complex Cancer Surgery

Abstract

Key Points Question What information may motivate the US public to travel to safer hospitals for complex cancer surgery, what barriers to traveling do they face, and what solutions may facilitate appropriately changing hospitals? Findings In this nationally representative survey study, 92% of respondents would be motivated to travel to a specialty cancer hospital for superior safety or oncologic outcomes, but 74% also reported barriers to traveling, although most of the barriers could be overcome with proposed solutions. Specific socioeconomic subsets were less likely to travel. Meaning It appears that most of the US public could be motivated to travel to safer hospitals for complex cancer surgery, yet most would require some support to move. Further efforts to ensure that benefits from regionalization are equitable across sociodemographic strata are indicated.

Lung Cancer Surgical Regionalization Disproportionately Worsens Travel Distance for Rural Patients

“…[20][21][22][23][24][25] From a patient perspective, travel distance is seen as a barrier to care, and some are willing to accept a higher risk of mortality in order to reduce that burden. 26,27 Average travel distance is particularly long for the rural population. 17,18,20,23,28,29 As cancer care regionalizes, travel may exacerbate disparities for the rural population.…”

Effect of regionalization of endometrial cancer care on site of care and patient travel

“…Similarly, previous studies have shown that insurance coverage is often a significant barrier to receipt of care at specialized and tertiary care centers. 34 We noted that the change in travel distance was more modest for Medicaid recipients than for patients with commercial insurance or Medicare coverage. Our findings are likely due in part to the geographic features of New York.…”

Navigating by Stars: Using CMS Star Ratings to Choose Hospitals for Complex Cancer Surgery

“…Other reassignment models, based on volume or safety performance, predict a larger impact and require as few as 15 patients to change hospitals to save 1 life ( 4 ). Given the many barriers that patients face when choosing hospitals, the likelihood of a reassignment strategy working is almost certainly tied to the number of patients required to move ( 39 ). On the other, the movement of higher risk patients (including those underdoing esophagectomy and pancreaticoduodenectomy) may actually be more reasonable (but again, this is less effective compared with other models).…”