Association of treatment and outcomes of doctor-shopping behavior in patients with hepatocellular carcinoma

Abstract

Cheng-I Hsieh,1–3 Kuo-Piao Chung,3 Ming-Chin Yang,3 Tsai-Chung Li4–61Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, 2Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 3Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, 4Graduate Institute of Biostatistics, College of Public Health, China Medical University, 5Graduate Institute of Chinese Medicine Science, College of Chinese Medicine, China Medical University, 6Department of Healthcare Administration, College of Health Science, Asia University, Taichung, TaiwanBackground: A variety of unfulfilled needs may trigger doctor-shopping behavior (DSB) in patients. In oncology, treatment results usually cause patients the most concern. This study investigated the association of DSB with active treatments received by patients with hepatocellular carcinoma (HCC) and outcomes.Methods: With approval from the institutional review board, all patients registered in the cancer database of a teaching hospital and diagnosed as having HCC by self-referral from outside hospitals or by in-house diagnosis were retrospectively identified. Patient data were then reviewed and analyzed via electronic medical records.Results: Hepatitis B carriers were significantly more likely than noncarriers to show first-time DSB. Recurrent disease was less likely to result in DSB than predicted. Patients from outside hospitals not receiving upfront first treatment after diagnosis were significantly more likely to show more frequent DSB than those receiving it. Male patients eligible for salvage treatment were less likely to have frequent occurrences of DSB than their female counterparts. Receiving first salvage treatment was not associated with more frequent DSB. Treatment recommendations offered in the study hospital did not influence patients' decisions to leave or stay. Only elderly patients (>70 years) were less likely to show DSB.Conclusion: DSB can occur throughout the entire course of treatment for HCC for a variety of reasons. Active treatments, disease status, and patient characteristics all exerted an influence on DSB.Keywords: doctor-shopping behavior, second opinion, hepatocellular carcinoma