Health System Barriers to the Discussion of Breast Reconstruction Options in Australia: Improving Access Through Appropriate Referral

Background: This study aimed to document referral-based barriers impeding Australian women's informed decision-making about breast reconstruction (BR) and to propose a designated BR referral pathway to help overcome these barriers. Methods: Semi-structured, in-depth interviews were conducted with ten women previously treated for breast cancer, 9 breast and reconstructive surgeons and 6 health professionals [n=25] who had identified problems with referrals for BR. Results: Referral-based barriers to BR discussion were identified at three different levels: from a public or private screening centre to a General Practitioner (GP) or breast surgeon; from a GP to a breast surgeon; and from one breast surgeon (without BR skills) to another breast or plastic reconstructive surgeon (with BR skills). A lack of designated referral pathways has meant that clinically eligible women who are interested in considering immediate BR have been denied this opportunity. Conclusions: Streamlining referral processes, along with patient and clinician education, would help to ensure that women are at least seen by the most appropriate clinicians to discuss BR options and to maximise their opportunity for BR should they choose that option. Designated referral pathways could also be useful in ensuring that preference-sensitive treatment decisions are facilitated in settings with varying degrees of resources and in a range of clinical conditions.