Patient preferences for location of cancer surgery in a community cancer affiliate network

Cancer centers are increasingly affiliating with regional hospitals, creating hub-spoke models for care delivery. Patient perspectives on accessing surgical cancer care within these systems are not well understood. The study purpose was to understand patient perceptions of hub-spoke models of care delivery and how they influence decisions regarding where to seek surgical care for cancer.

We conducted semistructured interviews with patients from a rural catchment area who underwent surgery for breast cancer at a hub cancer center or its rural affiliate spoke hospital. We performed collaborative coding using both inductive and deductive coding strategies. Within- and cross-case analyses were performed, emphasizing factors in participants' choice of location for surgery and their impressions of the hub-spoke network affiliation.

There were 18 participants who underwent breast cancer surgery at the hub (n = 8) or spoke (n = 10). Participants had universally favorable impressions of the hub hospital brand while they expressed mixed opinions about the spoke hospital. When choosing a hospital for surgery, participants considered their medical condition, access, and perceived quality. Although some were not influenced by the affiliate relationship (either because they would seek local care regardless or because they preferred to travel to the high-volume hub), for others the affiliate relationship provided excellent synergy, enabling them to access hub-quality care within their own community.

Findings highlight unique patient perspectives that require distinct considerations when designing affiliate network models for surgical cancer care.