Helene Retrouvey1, Ogi Solaja1, Anna R Gagliardi1, Fiona Webster1, Toni Zhong1. 1. From the Division of Plastic and Reconstructive Surgery, Toronto General Hospital; the Queen's University School of Medicine; the University Health Network; and the Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto.
Abstract
BACKGROUND: The purpose of this systematic review was to comprehensively summarize barriers of access to breast reconstruction and evaluate access using the Penchansky and Thomas conceptual framework based on the six dimensions of access to care. METHODS: The authors performed a systematic review that focused on (1) breast reconstruction, (2) barriers, and (3) breast cancer. Eight databases (i.e., EMBASE, MEDLINE, PsycINFO, CINHAL, ePub MEDLINE, ProQuest, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials) were searched. English peer-reviewed articles published between 1996 and 2016 were included. RESULTS: The authors' search retrieved 4282 unique articles. Two independent reviewers screened texts, selecting 99 articles for inclusion. All studies were observational and qualitative in nature. The availability of breast reconstruction was highest in teaching hospitals, private hospitals, and national cancer institutions. Accessibility affected access, with lower likelihood of breast reconstruction in rural geographic locations. Affordability also impacted access; high costs of the procedure or poor reimbursement by insurance companies negatively influenced access to breast reconstruction. Acceptability of the procedure was not universal, with unfavorable physician attitudes toward breast reconstruction and specific patient and tumor characteristics correlating with lower rates of breast reconstruction. Lastly, lack of patient awareness of breast reconstruction reduced the receipt of breast reconstruction. CONCLUSIONS: Using the access-to-care framework by Penchansky and Thomas, the authors found that barriers to breast reconstruction existed in all six domains and interplayed at many levels. The authors' systematic review analyzed this complex relationship and suggested multiprong interventions aimed at targeting breast reconstruction barriers, with the goal of promoting equitable access to breast reconstruction for all breast cancer patients.
BACKGROUND: The purpose of this systematic review was to comprehensively summarize barriers of access to breast reconstruction and evaluate access using the Penchansky and Thomas conceptual framework based on the six dimensions of access to care. METHODS: The authors performed a systematic review that focused on (1) breast reconstruction, (2) barriers, and (3) breast cancer. Eight databases (i.e., EMBASE, MEDLINE, PsycINFO, CINHAL, ePub MEDLINE, ProQuest, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials) were searched. English peer-reviewed articles published between 1996 and 2016 were included. RESULTS: The authors' search retrieved 4282 unique articles. Two independent reviewers screened texts, selecting 99 articles for inclusion. All studies were observational and qualitative in nature. The availability of breast reconstruction was highest in teaching hospitals, private hospitals, and national cancer institutions. Accessibility affected access, with lower likelihood of breast reconstruction in rural geographic locations. Affordability also impacted access; high costs of the procedure or poor reimbursement by insurance companies negatively influenced access to breast reconstruction. Acceptability of the procedure was not universal, with unfavorable physician attitudes toward breast reconstruction and specific patient and tumor characteristics correlating with lower rates of breast reconstruction. Lastly, lack of patient awareness of breast reconstruction reduced the receipt of breast reconstruction. CONCLUSIONS: Using the access-to-care framework by Penchansky and Thomas, the authors found that barriers to breast reconstruction existed in all six domains and interplayed at many levels. The authors' systematic review analyzed this complex relationship and suggested multiprong interventions aimed at targeting breast reconstruction barriers, with the goal of promoting equitable access to breast reconstruction for all breast cancerpatients.
Authors: Anna E Meade; Samantha M Cummins; Jordyn T Farewell; Sofia Duque; Sydney K Mulqueen; Ashleigh Chuah; Andrew Y Zhang Journal: Plast Reconstr Surg Glob Open Date: 2022-07-05
Authors: Lindsey N Urquia; Silas P Henderson; Jordyn T Farewell; Sofia Duque; Maycie Garibay; Julia Nevin; Andrew Y Zhang Journal: Aesthet Surg J Open Forum Date: 2022-05-02
Authors: Jie Jane Chen; Rie von Eyben; Paulina M Gutkin; Erin Hawley; Frederick M Dirbas; Gordon K Lee; Kathleen C Horst Journal: Ann Surg Oncol Date: 2020-09-01 Impact factor: 5.344
Authors: Abdulwahid M Salih; Zuhair D Hammood; Fahmi H Kakamad; Karzan M Salih; Hiwa O Baba; Hunar A Hassan; Shvan H Mohammed; Goran A Qadir; Hemn A Hassan; Ismael Y Abdullah Journal: Int J Surg Case Rep Date: 2020-06-22
Authors: Cody L Mullens; J Andres Hernandez; Mary Ellen Conn; Stephenie Kennedy-Rea; Cristiane M Ueno Journal: Plast Reconstr Surg Glob Open Date: 2020-02-20