title: Association of treatment and outcomes of doctor-shopping behavior in patients with hepatocellular carcinoma.
abstract: BACKGROUND
  A variety of unfulfilled needs may trigger doctor-shopping behavior (DSB) in patients. In oncology, treatment results usually cause patients the most concern. This study investigated the association of DSB with active treatments received by patients with hepatocellular carcinoma (HCC) and outcomes.
  
  
  METHODS
  With approval from the institutional review board, all patients registered in the cancer database of a teaching hospital and diagnosed as having HCC by self-referral from outside hospitals or by in-house diagnosis were retrospectively identified. Patient data were then reviewed and analyzed via electronic medical records.
  
  
  RESULTS
  Hepatitis B carriers were significantly more likely than noncarriers to show first-time DSB. Recurrent disease was less likely to result in DSB than predicted. Patients from outside hospitals not receiving upfront first treatment after diagnosis were significantly more likely to show more frequent DSB than those receiving it. Male patients eligible for salvage treatment were less likely to have frequent occurrences of DSB than their female counterparts. Receiving first salvage treatment was not associated with more frequent DSB. Treatment recommendations offered in the study hospital did not influence patients' decisions to leave or stay. Only elderly patients (>70 years) were less likely to show DSB.
  
  
  CONCLUSIONS
  DSB can occur throughout the entire course of treatment for HCC for a variety of reasons. Active treatments, disease status, and patient characteristics all exerted an influence on DSB.
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital ; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University ; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei.
authors.forename: Cheng-I
authors.initials: CI
authors.lastname: Hsieh
authors.forename: Kuo-Piao
authors.initials: KP
authors.lastname: Chung
authors.forename: Ming-Chin
authors.initials: MC
authors.lastname: Yang
authors.forename: Tsai-Chung
authors.initials: TC
authors.lastname: Li
keywords: doctor-shopping behavior; hepatocellular carcinoma; second opinion