Academic journal article Australian Health Review

What Is Access to Radiation Therapy? A Conceptual Framework and Review of Influencing Factors

Academic journal article Australian Health Review

What Is Access to Radiation Therapy? A Conceptual Framework and Review of Influencing Factors

Article excerpt

Introduction

Extensive work has been directed towards defining optimal radiation therapy (RT) utilisation rates (RURs) in the management of cancer patients.1-15 Optimal RURs are evidence-based benchmarks for the uptake of RT for various clinical indications. Such benchmarks remain unrealised both in Australia and overseas.16-21 The gap between optimal and actual RUR has been attributed to inadequacies in RT access.

At a population level, it is accepted that for cancer patients to obtain optimal outcomes (cure, organ preservation and quality of life), those who may benefit from RT must have 'access' to it. 'Access' is a term that is widely used in the context of health service-related research, planning and political discussions. It is a multifaceted concept with many descriptions.22-24 The radiation oncology community has long felt that there are multiple factors (both infrastructure related and other) affecting actual RT utilisation, and this has become increasingly recognised in the wider community.25-30

The aim of the present study was to formulate a conceptual framework for the consideration of RT access by examining the literature for existing constructs and translating it to the context of RT services. We used this framework to identify and examine known and potential factors influencing RT access.

Methods

Defining RT access

Early descriptions of access recognised that access to a health service is more than simply the presence of a facility.31 Thus, models of access focused on service availability as well as the extent to which that service may be used as key dimensions. Service utilisation was felt to be influenced by factors such as the affordability and acceptability of the service to the consumer.32 It was also observed that patients' perceptions and practitioners' evaluations of need may differ and that organisational factors and customer satisfaction may affect access.22 Thus, concepts of access evolved to incorporate consumer preference in decision making as additional dimensions.33-35 Thus, Penchansky and Thomas described access as a multidimensional construct expressing the fit between the consumer and the health system.23 Recognition of the interaction between service supply and demand for care from consumers prompted definition of optimal access as the provision of the right service 'at the right time in the right place'.36 Expanding on that, the concept of equity in access was introduced by Mooney, who stated that 'equality of access is about equal opportunity'.24 Gulliford et al. discussed these concepts and proposed four key aspects to access: availability (opportunity to obtain health care), service utilisation, effectiveness of the service and equity.32

In recent years there has been further refinement to access models in recognition of consumers' autonomy in making treatment choices and an emerging focus on consumer empowerment.34,37 This implies that efforts to improve access need to ensure that the service is acceptable to the population that it seeks to serve and actively empower the consumer to use the services available. Furthermore,thereis recognition of 'candidacy', which describes the process by which a patient's suitability for treatment isjointly negotiated between the individual, thehealth service and health professionals.38

The concepts described above from access models were used to formulate a multidimensional, conceptual framework for RT access, shown in Fig. 1.

A review of the literature was conducted to identify factors reported to affect RT utilisation. The electronic databases searched, the host platform and date range of the databases searched were Ovid MEDLINE (1946-October 2014) and PsycINFO via OvidSP (1806-October 2014). Search terms used were'radiotherapy'or'radiationtherapy',andeither 'utilisation', 'utilization' or 'uptake',or'barrier*',or'access'. Review of the articles generated was restricted to those in English. Articles discussing factors affecting (actual or potential) RT utilisation were reviewed in detail and grouped within the conceptual framework shown in Fig. …

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