Stakeholder perspectives on optimal follow-up care : an interdisciplinary economic and psychological investigation into gynaecological cancer

Aims: This thesis employs an interdisciplinary health economic and health psychology perspective to explore and understand patients, their informal caregivers and Health Care Professionals preferences for gynaecology cancer follow-up care, with the overarching aim of improving the efficiency of care provision. Methods and Results: A systematic literature review (Chapter 2: n=8) identified that patients had different preferences for care to meet their need for reassurance: hospital follow-up, Specialist Nurse led telephone follow-up, General Practitioner led follow-up and/or self-management. Health Care Professionals valued multidisciplinary models of care and the self-management model of care given the need for a changing model of care. No studies of informal caregivers’ care preferences were identified. A qualitative study of patients (n=17) and their informal caregivers’ (n=7) preferences for care, based on their experience of care (Chapter 3), identified that follow-up was valued because of the reassurance it provides. For patients, ‘access to an expert’, ‘procedures’ and ‘holistic care’ provided reassurance. ‘System failures’ and ‘low self-confidence’ prevented reassurance. For informal caregivers, ‘person centred information’, which was met through the provision of ‘person centred access to care’, provided reassurance. The attributes generated from the systematic literature review (Chapter 2), qualitative study (Chapter 3) and other methods were compared (Chapter 4) for the purpose of designing a discrete choice experiment (Chapter 4-5). Attributes generated were dependant on the methods used to identify them (Chapter 4). A stated preference discrete choice experiment (Chapter 5) identified that patients (n=77), their informal caregivers (n=26) and Health Care Professionals (n=67) had different relative preferences, and were prepared to make differing trade-off’s for the model of gynaecology cancer follow-up preferred. Conclusion: This interdisciplinary thesis makes multiple novel contributions to health economics methodology and policy, raising key questions for evidence based decision making for the prudent changing model of care, within resource scarcity.