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Multi-Institutional Study of Referral Patterns for Gynecologic Oncology Consultation.
Joseph A DeMari1, Isheeta Madeka1, Joni K Evans2
1Section on Gynecologic Oncology, Wake Forest University School of Medicine, Winston-Salem, NC.
JCO Oncology Practice
|May 22, 2024
Summary
Timely referral to gynecologic oncologists (GO) is crucial for gynecologic cancer patients. Delays in referral are linked to public insurance and greater distance to specialists, highlighting a need for improved access to care.
Area of Science:
- Oncology
- Health Services Research
- Gynecology
Background:
- Evaluation by a gynecologic oncologist (GO) is linked to better outcomes for patients with gynecologic cancers.
- Factors influencing patient referrals to GO remain poorly understood.
Purpose of the Study:
- To investigate health care factors affecting patient referrals to gynecologic oncologists (GO).
- To identify determinants of timely versus prolonged referral intervals for gynecologic cancer care.
Main Methods:
- Retrospective review of 300 new patient records from six US gynecologic oncology clinics.
- Data collected included patient/disease characteristics, referral indications, provider specialties, and referring provider ZIP codes.
- Primary outcome: time from first evaluation to GO referral; secondary outcome: prolonged referral time (>75th percentile).
Main Results:
- Median time to referral was 15 days; mean distance to GO was 39.8 miles.
- Referrals were predominantly from obstetrician-gynecologists (71%). Emergency medicine evaluations shortened referral time significantly (P < .001).
- Public insurance (P = .001) and greater distance to GO (P = .010) were associated with longer referral times, while nonmetropolitan ZIP codes showed shorter times (P = .017).
Conclusions:
- Interventions are necessary to enhance the recognition and referral of patients requiring gynecologic oncology evaluation.
- Prioritizing community outreach and engagement with obstetrician-gynecologists is essential for improving referral timeliness.
