title: Do patients with gastrointestinal cancer want to decide where they have tests and surgery? A questionnaire study of provider choice.
abstract: Choice of provider has been an important strategy among policy makers, intended, in part, to drive improvements in quality and efficiency of healthcare. This study examined the information requirements, and decision-making experiences and preferences of patients who have had surgery for gastrointestinal cancer, to assess the status of provider choice in current practice.
  
  
  
  The single-item Control Preferences Scale was used to determine patients' experiences and preferences when being referred for tests, and choosing where to have surgery. Participants used a Likert scale to rate the importance of 23 information items covering a variety of structures, processes and outcomes at the hospital level and the department level. Participants were recruited by post and online.
  
  
  
  463 responses were analysed. Patients reported very low levels of involvement in provider choice, with their doctor deciding where they underwent tests or surgery in 77.0% and 81.8% of cases, respectively. Over two-thirds of participants would have preferred greater involvement in provider choice than they experienced. Of note, patient age and education were not associated with reported preferences. Information on how long patients with cancer wait for treatment, annual operative volume and postoperative mortality rate, as well as retained foreign bodies and infection rates were considered very important.
  
  
  
  There was a substantial unmet desire for greater involvement in provider choice among study participants. Respondents attached particular importance to surgery-specific information. Efforts should be made to increase involvement of patients with gastrointestinal cancer in provider decisions, across primary and secondary care, to deliver more patient-centred care. The reported lack of patient involvement in provider choice suggests it is unlikely to be working as an effective lever to drive quality improvement at present.
authors.affiliation: Patient Safety Translational Research Centre, Imperial College London, London, UK.
authors.forename: Ben E
authors.initials: BE
authors.lastname: Byrne
authors.affiliation: Department of Surgical Epidemiology, Trials and Outcome Centre, St Mark's Hospital, Harrow, UK.
authors.forename: Omar D
authors.initials: OD
authors.lastname: Faiz
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Vincent
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D057240:Patient Preference; D011795:Surveys and Questionnaires
keywords: Decision making; Health policy; Health services research; Patient-centred care; Surgery