Examining the multilevel factors on quality of end-of-life care among cancer patients in Puerto Rico

检查影响波多黎各癌症患者临终关怀质量的多层次因素

基本信息

  • 批准号:
    10557584
  • 负责人:
  • 金额:
    $ 23.35万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2023
  • 资助国家:
    美国
  • 起止时间:
    2023-09-19 至 2028-08-31
  • 项目状态:
    未结题

项目摘要

PROJECT SUMMARY/ABSTRACT In the United States (US) and Puerto Rico (PR), cancer is the second leading cause of death. Considering that the population is aging, an increase in the burden of cancer is expected in future years. Consequently, quality of care at the end of life (EoL) is critical for dying cancer patients and their families. Studies in the US have shown that EoL care is expensive for cancer patients and frequently has very low or no clinical value, and often is inconsistent with the patient's needs, values, and preferences. Conversely, timely receipt of palliative and hospice care can improve quality of life and decrease emergency department visits, hospitalizations, and the use of life-extending procedures. Even when progress is made towards improving the quality of EoL care, a growing body of evidence shows disparities among groups within the population. Understanding the different characteristics that affect the quality of care at the EoL is fundamental to implementing effective interventions to reduce inequity and improve the efficiency of the healthcare delivery system. There are few studies in the US and no study in PR evaluating the quality of EoL care from the multilevel perspective. This proposal would be the first of such a series of investigations. PR has a predominantly Hispanic, low-income, and aging population with high insurance coverage. Forty-eight percent of the PR population lives below the poverty level, and there is a shortage of medical specialists, including palliative medicine. This study provides an opportunity to investigate the variations in the use of recommended care, its cost, and the provider and patient's behaviors towards EoL decisions. This study seeks to advance our knowledge and understanding of EoL care among cancer patients by utilizing state-of- the-art claims data analytics coupled with surveys data collection. Towards this effort, we will merge the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database with CMS hospice claims data and conduct physicians, patients, and caregivers’ surveys. Specific Aims are: 1) Assess the use of recommended care and the cost of care among cancer patients nearing EoL in PR; 2) Examine the perceived barriers to EoL discussion and decision-making process among oncologists in PR; and 3) Determine the knowledge, attitudes, and EoL planning among cancer patients and their caregivers in PR. This study will provide new evidence that will help us understand the complex process of EoL care and how different factors interact. Our most important contribution will be to document the potential multilevel influences on EoL care. This information will be essential for developing and implementing a multilevel intervention to improve the quality of care at the EoL. We expect our results can help improve health care delivery and enhance cancer patients' overall quality of life in a cost-effective way.
项目摘要/摘要 在美国和波多黎各,癌症是第二大死因。考虑到 人口正在老龄化,预计未来几年癌症负担将会增加。因此,质量 临终关怀(EoL)对临终癌症患者及其家人至关重要。在美国的研究已经 表明EoL治疗对于癌症患者来说是昂贵的,而且通常很低或没有临床价值,而且通常 与患者的需求、价值观和偏好不一致。相反,及时收到姑息性和 临终关怀可以提高生活质量,减少急诊科就诊、住院和 使用延长生命的程序。即使在改善EoL护理质量方面取得了进展, 越来越多的证据表明,人口中的群体之间存在差异。了解不同的 影响EoL护理质量的特征是实施有效干预的基础 减少不公平,提高医疗保健服务体系的效率。关于这方面的研究很少。 美国和没有从多层次角度评估EoL护理质量的公关研究。这项提议将 成为这一系列调查中的第一个。公关主要是西班牙裔、低收入和老龄化 保险覆盖率高的人群。 48%的PR人口生活在贫困线以下,医疗资源短缺 专家,包括姑息医学。这项研究提供了一个机会来调查 推荐护理的使用,其成本,以及提供者和患者对EoL决策的行为。本研究 寻求通过利用最新状态来增进我们对癌症患者EoL护理的认识和理解 最先进的数据分析与调查数据收集相结合。为了这一努力,我们将合并波多黎各 RICO中央癌症登记处-健康保险数据库与CMS临终关怀索赔数据和行为 医生、病人和照顾者的调查。具体目标是:1)评估推荐护理的使用情况和 PR中接近EoL的癌症患者的护理费用;2)检查EoL的感知障碍 PR中肿瘤学家之间的讨论和决策过程;以及3)决定知识、态度、 公关中癌症患者及其照顾者的EoL计划。这项研究将提供新的证据 将帮助我们了解EoL护理的复杂过程以及不同因素如何相互作用。我们最重要的 其贡献将是记录对EoL护理的潜在多层面影响。 这些信息对于制定和实施多层次干预措施以改善 EoL的护理质量。我们希望我们的研究结果能帮助改善医疗保健服务,提高癌症的发病率 以符合成本效益的方式提高患者的整体生活质量。

项目成果

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