title: Accessibility and Barriers to Oncology Appointments at 40 National Cancer Institute-Designated Comprehensive Cancer Centers: Results of a Mystery Shopper Project.
abstract: Patients turn to National Cancer Institute (NCI) -designated comprehensive cancer centers because of perceived better quality and more timely access to care. However, recent studies have found that patients at various institutions may struggle to gain access to an appointment or obtain consistent information from attendants. Our study employs a mystery shopper format to identify and quantify barriers faced by patients seeking to make a first consultation appointment across a homogenous sample of 40 NCI-designated comprehensive cancer centers.
  
  
  
  Five mystery shoppers used a standardized call script to inquire about first available appointment times and service offerings.
  
  
  
  When inquiring about a date for a first available appointment, 29% of callers were unable to secure an estimated date without registering into the center's database, 51% were able to secure an estimated date, and 20% were provided with an actual date. Of estimated or actual dates for a first available appointment, 74% were greater than 1 week away. There was no statistically significant variation between appointment availability across insurance type or US region.
  
  
  
  Our study highlights the difficulty of accessing information about appointment availability. Although not statistically significant, inquiries regarding first available appointments for Medicaid patients resulted in longer estimated or actual wait times than those for patients with private insurance, and Medicaid shoppers noted qualitative differences. Although our study was limited by small sample size and imperfect analytic methods, our results suggest the need for more efficient and accessible care for patients at our nation's top cancer centers.
authors.affiliation: Duke University; Duke Cancer Institute; and Duke University School of Medicine, Durham, NC.
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Hamlyn
authors.affiliation: Duke University; Duke Cancer Institute; and Duke University School of Medicine, Durham, NC.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Hutchins
authors.affiliation: Duke University; Duke Cancer Institute; and Duke University School of Medicine, Durham, NC.
authors.forename: Abby L
authors.initials: AL
authors.lastname: Johnston
authors.affiliation: Duke University; Duke Cancer Institute; and Duke University School of Medicine, Durham, NC.
authors.forename: Rishonda T
authors.initials: RT
authors.lastname: Thomas
authors.affiliation: Duke University; Duke Cancer Institute; and Duke University School of Medicine, Durham, NC.
authors.forename: James
authors.initials: J
authors.lastname: Tian
authors.affiliation: Duke University; Duke Cancer Institute; and Duke University School of Medicine, Durham, NC.
authors.forename: Arif H
authors.initials: AH
authors.lastname: Kamal
mesh_terms: D001071:Appointments and Schedules; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D008484:Medicaid; D008875:Middle Aged; D054547:National Cancer Institute (U.S.) / Q000706:statistics & numerical data*; D014481:United States