Haematology patients' desire to access metropolitan hospital expertise

Objective To date, there is limited research to inform an understanding of cancer patients' choice as to location of treatment. This paper makes a contribution by providing findings on a group of regional, rural and remote cancer patients, namely those diagnosed with a haematological malignancy, who have to relocate for specialist care in Queensland, Australia. Methods A descriptive qualitative method was used based on 45 in-depth interviews with haematology patients living in Queensland who were supported by the Leukaemia Foundation of Queensland. Results Four key factors were found to affect the decision making of patients who prefer to travel to metropolitan hospitals for specialist haematology treatments, namely access to own doctor, bonds and familiarity with metropolitan staff, desire for 'quality' specialist care and a distrust of local clinical care and, for some, the absence of usual barriers to visiting the metropolitan area. Conclusions There are a group of patients who have experiences that lead them to distrust non-metropolitan hospitals and motivate them to travel long distances to attend specialist treating centres for 'quality' care. The literature affirms the concerns of this group. It is the hope and expectation in publishing this article that these patients' concerns will be taken into consideration in the development of health services and policy so that eventually all regional, rural and remote patients will be provided with equitable choice with regard to the location of accessing specialist care. What is known about the topic? The literature on haematology patients' experiences with and preferences for local verses metropolitan hospital treatment is limited. What does this paper add? To date, research on relocation for specialist treatment has documented the hardships for both patients and their families associated with distance from major treating hospitals. Although affirming the difficulties associated with travel and the desire of most haematology patients to be treated locally, this article completes the picture with detailed findings on a subset of patients who would prefer to travel to a metropolitan centre for treatment. What are the implications for practitioners? The issues with regard to relocation for specialist treatment are complex and associated with a range of 'trade-offs', both positive and negative, for haematology patients. Thus, with regard to both service delivery and health policy decision making, the full range of factors needs to be taken into consideration. This paper indicates that, for a subgroup of haematology patients, their experience and beliefs about issues of quality of care are paramount.