BACKGROUND. Decisions to refer patients to other physicians for care or con
sultation are an important component of the provision of appropriate care f
or cancer patients. However, little is known about the referral process bet
ween specialists.
OBJECTIVES. To examine the referral patterns of specialists to specialists
and to understand why only some breast cancel patients receive a consultati
on with a medical oncologist.
RESEARCH DESIGN. This study was conducted in a large metropolitan region fr
om 1993 to 1995 using a 2-staged population-based sampling strategy. One hu
ndred seven physicians discussed 244 patient cases and their own knowledge,
attitudes, and practices toward treatment and referral.
RESULTS. Of the 244 patients, 87.7% were referred to an oncologist, and 10.
2% were actually prescribed tamoxifen by their surgeons before they saw the
oncologist. Surgeons who were less involved in making decisions about the
type of adjuvant therapy the patients were to receive and who preferred the
use of chemotherapy were significantly more likely to refer patients to on
cologists. Patients who were older, unemployed, node negative, and had a be
tter prognosis or preferred not to see an oncologist were significantly les
s likely to be referred. These 7 factors explained a total of 55% of the va
riation in surgeons' decisions to refer patients to an oncologist.
CONCLUSIONS. Extramedical factors, such as surgeon and patient preferences
and communication factors, play a strong role in the referral process. In t
his sample, most patients were referred to an oncologist, However, older, u
nemployed patients and patients whose medical features indicated a better l
ong-term prognosis were most likely to be among the nonreferred group.