Health System Barriers to the Discussion of Breast Reconstruction Options in Australia: Improving Access Through Appropriate Referral

Background: This study aimed to document referral-based barriers impedingAustralian women's informed decision-making about breast reconstruction (BR)and to propose a designated BR referral pathway to help overcome these barriers.Methods: Semi-structured, in-depth interviews were conducted with ten womenpreviously treated for breast cancer, ۹ breast and reconstructive surgeons and ۶health professionals [n=۲۵] who had identified problems with referrals for BR.Results: Referral-based barriers to BR discussion were identified at threedifferent levels: from a public or private screening centre to a General Practitioner(GP) or breast surgeon; from a GP to a breast surgeon; and from one breast surgeon(without BR skills) to another breast or plastic reconstructive surgeon (with BRskills). A lack of designated referral pathways has meant that clinically eligiblewomen who are interested in considering immediate BR have been denied thisopportunity.Conclusions: Streamlining referral processes, along with patient and clinicianeducation, would help to ensure that women are at least seen by the mostappropriate clinicians to discuss BR options and to maximise their opportunity forBR should they choose that option. Designated referral pathways could also beuseful in ensuring that preference-sensitive treatment decisions are facilitated insettings with varying degrees of resources and in a range of clinical conditions.

Keywords:

Breast reconstruction , informed choice , breast cancer , referral pathways , health care reform , patient preferences