title: Incidence and contributing factors to termination of the patient-physician relationship.
abstract: OBJECTIVE
  Identify the incidence and factors contributing to the termination of gynecologic patient-physician relationships.
  
  
  METHODS
  All patients terminated from the practice between January 2008 and December 2012 were identified. Charts were reviewed for demographic information, termination reason, and cancer diagnosis.
  
  
  RESULTS
  In the five year study period, 8851 new patients presented to the division of gynecologic oncology. Within this cohort, 123 patient-physician relationships were terminated. Among terminated patients, missed appointments (63.4%), noncompliance to treatment (23.6%), disruptive behavior (10.6%), and drug abuse behavior (2.4%) were the key reasons for termination. While no patients were terminated for financial reason, statistical differences were found for those with Medicaid insurance (OR = 5; 95% CI: 3.4-7.1). Terminated patients were more likely to be younger, African American/Black, and have a diagnosis of GTD or cancer, particularly cervical cancer, when compared against all retained patients.
  
  
  CONCLUSIONS
  The prevalence of patient-physician relationship termination was low at 1.4% (123/8851). However, the finding that the 52% of terminated patients had a diagnosis of cancer is concerning; 73% of which had stage III or greater disease, or were unstaged. We hope that the identification and quantification of reasons for termination and those at risk for termination, as well as the introduction of patient-navigators, will lead to improved methods to ensure patient compliance and retention.
authors.affiliation: Division of Gynecology Oncology, University of Tennessee-West Cancer Center, Memphis, TN, United States.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Santoso
authors.affiliation: University of Tennessee Health Science Center, Memphis, TN, United States.
authors.forename: Edmundo
authors.initials: E
authors.lastname: Yibirin
authors.affiliation: Division of Gynecology Oncology, University of Tennessee-West Cancer Center, Memphis, TN, United States.
authors.forename: Mary
authors.initials: M
authors.lastname: Crigger
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States.
authors.forename: Jim
authors.initials: J
authors.lastname: Wan
authors.affiliation: Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solve Research Institute, Columbus, OH, United States.
authors.forename: Adam C
authors.initials: AC
authors.lastname: ElNaggar
keywords: Outcomes; Patient-centered care; Patient-physician relationship; Qualitative research