What sort of follow-up services would Australian breast cancer survivors prefer if we could no longer offer long-term specialist-based care? A discrete choice experiment

Introduction: Early diagnosis and improved treatment have increased breast cancer survival rates which, in turn, has led to increased demand for followup. The current workload growth is unsustainable for breast cancer specialists who also provide care for women newly diagnosed or with a recurrence. Appropriate and acceptable follow-up care is important, yet currently we know little about patient preferences. The purpose of this study was to determine the preferences of breast cancer survivors for alternative modes of delivery of follow-up services, if we could no longer offer long term specialist-led hospital based follow-up. Materials and methods: A self-administered questionnaire (on-line or paper) was developed. The questionnaire contained a discrete choice experiment (DCE) designed to explore patient preferences with respect to provider, location, frequency, and method of delivery of routine follow-up care; as well as perceived value of "drop-in" clinics providing additional support. Participants were recruited through breast surgeons (SA only), limited local and national print media, Cancer Voices SA, Cancer Council Australia, Breast Cancer Network of Australia, National Breast Cancer Foundation and Register 4, over a 6 month period from May to October 2012.Results: 836 women participated in the study, of whom 722 (86.4%) completed the DCE. Women demonstrated strongest positive preferences for a breast physician (followed by breast cancer nurses), 6-monthly visits, local breast cancer clinics, face-to-face attendances (followed by alternate face-toface and telephone), and treatment side-effects (followed by secondary prevention) drop-in clinics (all p < 0.01). Conclusions: Women prefer to have their routine breast cancer follow-up by a breast physician (or a breast cancer nurse) in a dedicated local breast cancer clinic, rather than with their local general practitioner. Drop-in clinics for the management of treatment related side-effects and to provide advice to both develop and maintain good health are also highly valued by breast cancer survivors.Taryn Bessen, Gang Chen, Jackie Street, Jaklin Eliott, Jonathan Karnon, Dorothy Keefe, Julie Ratcliff