Beyond Infrastructure: Understanding Why Patients Decline Surgery in the Developing World: An Observational Study in...

Area of Science:

• Global Health
• Surgical Care Access
• Health Economics

Background:

• 5 billion people globally lack access to safe, affordable surgical care, disproportionately affecting low-income countries (LICs).
• Understanding socioeconomic factors in patient decision-making is crucial for expanding surgical care delivery in LICs.
• This study examines patient decision-making in a cash-based healthcare economy in rural Cameroon.

Purpose of the Study:

• To quantify and describe patients in rural Cameroon who decline surgically treatable conditions.
• To understand the patient decision-making process regarding surgery.
• To identify socioeconomic factors creating barriers to surgical care.

Main Methods:

• Standardized interviews with adult patients with treatable surgical conditions in rural Cameroon.
• Random sampling over a 7-week period in a tertiary referral hospital.
• Outcome measures: surgery acceptance/decline, funding source, and decision factors.

Main Results:

• 19.4% of 175 patients declined recommended surgery.
• 76.4% of those declining cited procedure cost (averaging 6.4 months' income) as the primary factor.
• Declining surgery was associated with female gender, lower monthly earnings, supporting children, and inability to borrow funds.

Conclusions:

• A significant proportion of patients with treatable surgical conditions do not receive surgery.
• Both financial constraints and sociocultural factors influence the decision to decline surgical care.
• Addressing cost barriers and financial support is critical to improve surgical care access.