How do surgeons decide to refer patients for adjuvant cancer treatment? A qualitative study

Lung cancer (LC), breast cancer (BC), and colorectal cancer (CRC) are commonly diagnosed cancers, with the incidence of these cancers higher in Nova Scotia than nationally. Together, these cancers will account for nearly half of all cancer deaths in Canada in 2011. For patients diagnosed with early stage LC, BC, or CRC, surgery is the main treatment with other therapies (e.g., chemotherapy, radiation therapy) recommended depending on the cancer stage. To receive these therapies, which have been shown to increase the chance of survival and to decrease the chance that the cancer will return, a patient normally requires a consultation with a cancer therapy specialist (oncologist). However, data from Nova Scotia show that a large proportion of LC and CRC patients, for whom these additional therapies are recommended, are not referred to see an oncologist after their surgery. Thus, a better understanding of how surgeons make decisions about referring patients to oncologists is important to developing appropriate strategies to improve referral rates. The goals of this study are to identify the many factors that influence surgeons' decisions to refer LC, BC, and CRC patients to an oncologist when additional therapy is recommended and to identify potential strategies that could increase referral to oncology for appropriate individuals. For this study, we will seek to interview all surgeons who perform LC, BC, and CRC surgeries in Nova Scotia. We will ask surgeons to reflect on their decision-making processes related to referring cancer patients to oncologists and on the factors that influence their decisions. The information we gain will help fill an important gap in our understanding of how surgeons make decisions about their patients and will help us develop more effective ways to increase referral rates and thereby improve access to cancer services. This is important to increasing use of therapies in appropriate patients and, thus, improving patient outcomes.