title: What sort of follow-up services would Australian breast cancer survivors prefer if we could no longer offer long-term specialist-based care? A discrete choice experiment.
abstract: BACKGROUND
  Early diagnosis and improved treatment outcomes have increased breast cancer survival rates that, in turn, have led to increased numbers of women undergoing follow-up after completion of primary treatment. The current workload growth is unsustainable for breast cancer specialists who also provide care for women newly diagnosed or with a recurrence. Appropriate and acceptable follow-up care is important; yet, currently we know little about patient preferences. The aim of this study was to explore the preferences of Australian breast cancer survivors for alternative modes of delivery of follow-up services.
  
  
  METHODS
  A self-administered questionnaire (online or paper) was developed. The questionnaire contained a discrete choice experiment (DCE) designed to explore patient preferences with respect to provider, location, frequency and method of delivery of routine follow-up care in years 3, 4 and 5 after diagnosis, as well as the perceived value of 'drop-in' clinics providing additional support. Participants were recruited throughout Australia over a 6-month period from May to October 2012. Preference scores and choice probabilities were used to rank the top 10 most preferred follow-up scenarios for respondents.
  
  
  RESULTS
  A total of 836 women participated in the study, of whom 722 (86.4%) completed the DCE. In the absence of specialist follow-up, the 10 most valued surveillance scenarios all included a Breast Physician as the provider of follow-up care. The most preferred scenario is a face-to-face local breast cancer follow-up clinic held every 6 months and led by a Breast Physician, where additional clinics focused on the side effects of treatment are also provided.
  
  
  CONCLUSIONS
  Beyond the first 2 years from diagnosis, in the absence of a specialist led follow-up, women prefer to have their routine breast cancer follow-up by a Breast Physician (or a Breast Cancer Nurse) in a dedicated local breast cancer clinic, rather than with their local General Practitioner. Drop-in clinics for the management of treatment related side effects and to provide advice to both develop and maintain good health are also highly valued by breast cancer survivors.
authors.affiliation: School of Population Health, The University of Adelaide, Adelaide, South Australia 5000, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Bessen
authors.affiliation: School of Medicine, Flinders University, Adelaide, South Australia 5042, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Chen
authors.affiliation: School of Population Health, The University of Adelaide, Adelaide, South Australia 5000, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Street
authors.affiliation: School of Population Health, The University of Adelaide, Adelaide, South Australia 5000, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Eliott
authors.affiliation: School of Population Health, The University of Adelaide, Adelaide, South Australia 5000, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Karnon
authors.affiliation: School of Medicine, The University of Adelaide, Adelaide, South Australia 5000, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Keefe
authors.affiliation: School of Medicine, Flinders University, Adelaide, South Australia 5042, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Ratcliffe
mesh_terms: D000328:Adult; D001315:Australia; D001943:Breast Neoplasms / Q000401:mortality / Q000628:therapy*; D002755:Choice Behavior; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods*; D008875:Middle Aged; D057240:Patient Preference; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology