Oncologists' Attitudes towards Treating Patients with Advanced Cancer

 描述（由申请人提供）： 这项试点提案的目标是设计一项调查，以了解肿瘤学家对治疗晚期癌症患者的态度。具体而言，我们希望了解肿瘤学家在两个主要领域的态度：1）姑息治疗在治疗任何转移性癌症患者中的作用; 2）在为处于生命末期的转移性实体瘤患者（由受访者定义生命末期）做出治疗决策时的作用（如果有的话）。 因此，本研究的最终目的也是双重的：a）改善患者及时接受 姑息治疗，一项已被反复证明对癌症患者有实质性益处的服务;和B）提高肿瘤学家导向的价值策略的有效性。由于同行评审文献中对这一领域的调查研究很少，我们奋进创建一个高质量的调查，以中肯地询问肿瘤学家对转移性癌症患者的护理态度，我们开始通过进行半结构化访谈来了解肿瘤学家认为在考虑价值和姑息治疗时重要的领域和项目。我们对这些访谈进行定性分析，并使用结果为封闭式调查的设计提供信息。我们未来的目标包括与肿瘤学家一起对这项调查进行预测试，并编写一份提案，将这项调查传播给全国范围内的大样本肿瘤学家。我们对了解肿瘤学家对转移性癌症患者姑息治疗的态度的兴趣源于目前研究与实践之间存在的不一致。有大量证据表明，姑息治疗可以改善癌症患者的生活质量，减轻症状。绝大多数癌症专业协会也建议患者早期接受姑息治疗。然而，尽管有强大的证据基础和医疗质量机构的支持，许多癌症患者，无论是在VA内外，都没有接受任何姑息治疗，或者在疾病过程中提供姑息治疗，以至于他们无法认识到其全部益处。此外，肿瘤学家自己提供姑息治疗（初级姑息治疗）的程度完全未知。该提案旨在了解肿瘤学家对姑息治疗的看法，包括他们是否认为姑息治疗是一种有用的服务，当他们更愿意自己提供姑息治疗（初级姑息治疗）而不是转诊给姑息治疗专家（二级姑息治疗）时，以及他们认为姑息治疗的适当时机。该提案还旨在了解肿瘤学家认为在为生命末期的患者提供护理方面应该发挥的作用。在医疗保健领域，价值是指患者所取得的成果与为实现这些成果所花费的资源成比例。由于质量和成本都有助于这一定义，它避免了常见的陷阱，普遍存在于政治景观，f等同于简单的成本削减价值。评估癌症价值的重要性有很多原因，其中最重要的是患者因癌症相关医疗而面临的巨大经济困难。然而，价值，特别是成本，可能是一个有争议的话题;正是由于这个原因，我们认为经验探索的时机已经成熟。此外，由于确定生命终末期本身在肿瘤学家群体中存在争议，我们借此机会询问肿瘤学家对生命这一阶段的定义。我们相信，这项试点工作的结果，以及这项试点研究将提供的更大的建议工作的结果，将提供可以用于改善患者接受姑息治疗的信息来源，并提高以肿瘤学家为导向的价值策略的有效性。肿瘤学家既是姑息治疗的守门人，要么是因为他们自己提供姑息治疗，要么是因为他们把病人介绍给姑息治疗服务。他们还指导为患者购买护理服务。了解他们对照顾转移性癌症患者的态度是与临床医生合作的重要一步，以确保患者获得高价值的护理，最大限度地提高他们与健康相关的生活质量。

 DESCRIPTION (provided by applicant): The goal of this pilot proposal is to design a survey to elicit oncologists' attitudes towards treating patients with advanced cancer. Specifically, we wish to understand oncologists' attitudes in two main areas: 1) the role of palliative care in the treatment of any patient with metastatic cancer; and 2) the role, if any, of value in making treatment decisions for patients with metastatic solid tumors who are at the end-of-life (with end-of-life defined by interviewees). The ultimate purpose of this research is thus also twofold: a) to improve patient receipt of timely palliative care, a service that has been repeatedly shown to be of substantial benefit to patients with cancer; and b) to improve the effectiveness of oncologist-oriented value strategies. As this area of inquiry has been little studied in the peer-reviewed literature, and we endeavor to create a high- quality survey that cogently queries oncologists about their attitudes towards caring for patients with metastatic cancer, we begin by conducting semi-structured interviews to understand the domains and items oncologists feel are important in considering value and palliative care. We conduct qualitative analyses of these interviews and use results to inform design of a closed-ended survey. Our future goals include pre-testing this survey with oncologists, and writing a proposal to disseminate this survey to a large sample of oncologists nationwide. Our interest in understanding oncologists' attitudes towards palliative care for patients with metastatic cancer stems from the incongruence that currently exists between research and practice. There is a strong body of evidence indicating that palliative care improves quality of life and reduces symptoms for patients with cancer. The vast majority of cancer specialty societies also recommend early exposure to palliative care for patients. However, despite the strong evidence base and support from the quality-of-care establishment, many cancer patients, both within and outside of VA, do not receive any palliative care, or are provided palliative care so late in the course of disease they are not able to recognize its full benefit. Furthermore, the extent to which oncologists provide palliative care themselves (primary palliative care) is entirely unknown. This proposal aims to understand oncologists' perceptions of palliative care, including whether they consider it to be a useful service, when they prefer to provide it themselves (primary palliative care) versus refer out to palliative care specialists (secondary palliative care), and what they feel is the appropriate timing of palliative care. This proposal also aims to understand the role oncologists feel value should play in the provision of care for patients at the end-of life. In healthcare, value indicates an achievement of patient outcomes proportional to the resources spent to achieve them. As both quality and cost contribute to this definition, it avoids the common pitfall, prevalent in the political landscape, f equating value with simple cost cutting. Value in cancer can be important to evaluate for a number of reasons, not the least of which is the substantial financial difficulties patients face a a result of their cancer-related medical treatment. However, value, and in particular costs, can be a contentious topic; it is for this reason we feel it is ripe for empirical exploration. Additioally, as determining end-of-life itself is debated within the oncologist community, we take this opportunity to query oncologists about their definitions of this stage of life. We believe results from this pilot work, and from the larger proposal work this pilot study will inform, will provide ey sources of information that can be used to improve patients' receipt of palliative care as appropriate, and to improve the effectiveness of oncologist-oriented value strategies. Oncologists are both the gatekeepers to palliative care, either because they provide it themselves or refer patients to palliative care services. They also guide the purchasing of care for their patients. Understanding their attitudes towards caring for patients with metastatic cancer is a vital step in partnering with clinicians to ensure patients receive high-value care tha maximizes their health-related quality of life.