title: Referral patterns for patients with high-risk thyroid cancer.
abstract: OBJECTIVE
  Knowledge of referral patterns for specialty cancer care is sparse. Information on both the need and reasons for referral of high-risk, well-differentiated thyroid cancer patients should provide a foundation for eliminating obstacles to appropriate patient referrals and improving patient care.
  
  
  METHODS
  We surveyed 370 endocrinologists involved in thyroid cancer management. From information in a clinical vignette, respondents were asked to identify the reasons they would need to refer a high-risk patient to a more specialized facility for care. We performed multivariable analysis controlling for hospital and physician characteristics.
  
  
  RESULTS
  Thirty-two percent of respondents reported never referring thyroid cancer patients to another facility. Of those that would refer a high-risk patient to another facility, the opportunity for a patient to enter a clinical trial was the most common reason reported (44%), followed by high-dose radioactive iodine (RAI) with or without dosimetry (33%), lateral neck dissection (24%), and external beam radiation (15%). In multivariable analysis, endocrinologists with a higher percentage of their practice devoted to thyroid cancer care were significantly less likely to refer patients to another facility (P = .003).
  
  
  CONCLUSIONS
  The majority of endocrinologists treating thyroid cancer patients report referring a high-risk patient to another facility for some or all of their care. Knowledge of the patterns of physician referrals and the likelihood of need for referral are key to understanding discrepancies in referral rates and obstacles in the referral process.
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, MI 48109-2800, USA. meganhay@umich.edu
authors.forename: Megan R
authors.initials: MR
authors.lastname: Haymart
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.forename: Di
authors.initials: D
authors.lastname: Yang
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Stewart
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Griggs
authors.forename: James C
authors.initials: JC
authors.lastname: Sisson
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Koenig
mesh_terms: D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013964:Thyroid Neoplasms