Exploring inequalities in access to care and the provision of choice to women seeking breast reconstruction surgery: a qualitative study.
BACKGROUND
Breast reconstruction (BR) may improve psychosocial and cosmetic outcomes after mastectomy for breast cancer but currently, few women opt for surgery. Reasons for this are unclear. The aim of this qualitative study was to explore access to care and the provision of procedure choice to women seeking reconstructive surgery.


METHODS
Semi-structured interviews with a purposive sample of patients who had undergone BR and professionals providing specialist care explored participants' experiences of information provision before BR. Interviews were transcribed verbatim and analysed using the constant comparative technique of grounded theory. Sampling, data collection and analysis were performed concurrently and iteratively until data saturation was achieved.


RESULTS
Both patients and professionals expressed concerns about the provision of adequate procedure choice and access to care. Lack of information and/or time, involvement in decision making and issues relating to the evolution and organisation of reconstructive services, emerged as potential explanations for the inequalities seen. Interventions to improve cross-speciality collaboration were proposed to address these issues.


CONCLUSIONS
Inequalities in the provision of choice in BR exist, which may be explained by a lack of integration between surgical specialities. Pathway restructuring, service reorganisation and standardisation of training may enhance cross-speciality collaboration and improve the patient experience.
Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK. Shelley.Potter@bristol.ac.uk
S
S
Potter
N
N
Mills
S
S
Cawthorn
S
S
Wilson
J
J
Blazeby
D002755:Choice Behavior; D003625:Data Collection; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000379:methods / Q000523:psychology; D008408:Mastectomy / Q000523:psychology; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires