A decision exercise to engage cancer patients and families in deliberation about Medicare coverage for advanced cancer care.
A decision exercise to engage cancer patients and families in deliberation about Medicare coverage for advanced cancer care.
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DOI：
10.1186/1472-6963-14-315
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发表时间：
2014-07-19
影响因子：
2.8
通讯作者：
Taylor DH Jr
中科院分区：
文献类型：
--
作者：
Danis M;Abernethy AP;Zafar SY;Samsa GP;Wolf SP;Howie L;Taylor DH Jr
随着退休人员数量的增加以及患上癌症等严重且昂贵的疾病，人们对美国医疗保险计划中不可持续的成本感到担忧。利益相关者的参与，特别是癌症患者及其家属，在优先保险服务提供了一个有价值的战略，告知医疗保险覆盖政策。我们设计并评估了一个决策练习，允许癌症患者和家庭成员选择晚期癌症患者的医疗保险福利。对决策工具“共同选择健康计划”（CHAT）进行了修改，以选择为晚期癌症患者提供的服务。来自北卡罗来纳州的有癌症病史的患者（N = 246）及其家庭成员（N = 194）参加了70次CHAT会议。收集的变量包括参与者的社会人口特征、健康状况、运动评估和团体福利选择结果。常规描述性统计总结了参与者的特征，Fisher精确检验比较了组间差异。小组讨论的定性分析被用来确定原因或反对选择的好处。患者和家属（N = 440）参加了70个聊天练习。许多团体选择了姑息治疗、护理设施和目前未被医疗保险计划覆盖的服务。在选择四个癌症治疗覆盖率水平时，没有任何群体选择基本覆盖率，27个群体（39%）选择中等覆盖率，39个群体（56%）选择高覆盖率，4个群体（6%）选择最全面的癌症覆盖率。支持或反对福利选择的原因包括公平性、必要性、优先考虑的必要性、个人经验、对家庭需求的关注、整体健康观、对舒适的偏好、选择的自由以及对政府适当角色的信念。参与者认为这项练习非常容易（59%）或相当容易（39%）理解，信息量很大（66%）或相当丰富（31%）。大多数人同意，CHAT活动导致就他们可以遵守的覆盖范围的优先事项作出公平的决定。通过使用为此目的设计的决策工具，有可能让癌症患者和家庭明确讨论他们优先考虑负担得起的先进癌症护理。一个关键问题是，这样的对话是否可能在更广泛的国家层面上进行。
Concerns about unsustainable costs in the US Medicare program loom as the number of retirees increase and experiences serious and costly illnesses like cancer. Engagement of stakeholders, particularly cancer patients and their families, in prioritizing insured services offers a valuable strategy for informing Medicare coverage policy. We designed and evaluated a decision exercise that allowed cancer patients and family members to choose Medicare benefits for advanced cancer patients. The decision tool, Choosing Health plans All Together (CHAT) was modified to select services for advanced cancer patients. Patients with a cancer history (N = 246) and their family members (N = 194) from North Carolina participated in 70 CHAT sessions. Variables including participants’ socio-demographic characteristics, health status, assessments of the exercise and results of group benefit selections were collected. Routine descriptive statistics summarized participant characteristics and Fisher’s exact test compared group differences. Qualitative analysis of group discussions were used to ascertain reasons for or against selecting benefits. Patients and family members (N = 440) participated in 70 CHAT exercises. Many groups opted for such services as palliative care, nursing facilities, and services not currently covered by the Medicare program. In choosing among four levels of cancer treatment coverage, no groups chose basic coverage, 27 groups (39%) selected intermediate coverage, 39 groups (56%) selected high coverage, and 4 groups (6%) chose the most comprehensive cancer coverage. Reasons for or against benefit selection included fairness, necessity, need for prioritizing, personal experience, attention to family needs, holistic health outlook, preference for comfort, freedom of choice, and beliefs about the proper role of government. Participants found the exercise very easy (59%) or fairly easy (39%) to understand and very informative (66%) or fairly informative (31%). The majority agreed that the CHAT exercise led to fair decisions about priorities for coverage by which they could abide. It is possible to involve cancer patients and families in explicit discussions of their priorities for affordable advanced cancer care through the use of decision tools designed for this purpose. A key question is whether such a conversation is possible on a broader, national level.
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影响因子：
2.3
作者：
Danis, Marion;Ginsburg, Marjorie;Goold, Susan
通讯作者：
Goold, Susan
影响因子：
9.7
作者：
Etheredge, Lynn M.
通讯作者：
Etheredge, Lynn M.
DOI：
10.14694/edbook_am.2012.32.e46
发表时间：
2012-01-01
期刊：
American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting
影响因子：
--
作者：
Smith, Thomas J;Hillner, Bruce E;Kelly, Ronan J
通讯作者：
Kelly, Ronan J
DOI：
10.1177/1049909112461064
发表时间：
2013-09-01
影响因子：
1.9
作者：
Taylor, Donald H., Jr.
通讯作者：
Taylor, Donald H., Jr.
影响因子：
120.7
作者：
Steinhauser, AE;Christakis, NA;Tulsky, JA
通讯作者：
Tulsky, JA