Oncologists' Attitudes towards Treating Patients with Advanced Cancer

肿瘤科医生对治疗晚期癌症患者的态度

• 批准号: 8982942
• 负责人: Risha Gidwani Marszowski
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8982942
• 关键词: Achievement; Address; Advanced Malignant Neoplasm; American Society of Clinical Oncology; Area; Attitude; Behavior; Cancer Patient; Caring; Categories; Cessation of life; Communities; Disease; Disseminated Malignant Neoplasm; Effectiveness; Ensure; Exposure to; Face; Family; Future; Gatekeeping; Goals; Health; Health Benefit; Healthcare; Influentials; Institute of Medicine (U.S.); Institution; Interview; Investigator-Initiated Research; Life; Literature; Malignant Neoplasms; Medical; Medicine; Methods; National Comprehensive Cancer Network; Oncologist; Outcome; Palliative Care; Patient Care; Patients; Peer Review; Perception; Physicians; Pilot Projects; Planning Theory; Play; Quality of Care; Quality of life; Questionnaires; Research; Research Personnel; Research Proposals; Resources; Review Literature; Role; SEER Program; Sampling; Services; Societies; Solid Neoplasm; Source; Specialist; Staging; Structure; Surveys; Symptoms; System; Testing; Time; Treatment Cost; United States; Veterans; Work; Writing; base; cost; design; end of life; evidence base; experience; health related quality of life; improved; interest; medical specialties; oncology; palliative; stem; tumor

 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.

 描述(由申请人提供)： 这项试点计划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。具体地说，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)价值在对处于生命末期(受访对象定义为生命末期)的转移性实体肿瘤患者做出治疗决定方面的作用(如果有的话)。 因此，这项研究的最终目的也有两个：a)提高患者的及时性 姑息治疗，这是一项一再被证明对癌症患者有实质性好处的服务；和b)提高以肿瘤学家为导向的价值策略的有效性。由于在同行评议的文献中对这一领域的研究很少，我们努力创建一个高质量的调查，有力地询问肿瘤学家关于他们对治疗转移性癌症患者的态度，我们首先进行半结构化访谈，以了解肿瘤学家认为在考虑价值和姑息治疗方面重要的领域和项目。我们对这些访谈进行定性分析，并使用结果来指导封闭式调查的设计。我们未来的目标包括与肿瘤学家预先测试这项调查，并撰写一份提案，将这项调查传播到全国范围内的肿瘤学家的大样本中。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和实践之间存在的不一致。有大量证据表明，姑息治疗改善了癌症患者的生活质量，减轻了他们的症状。绝大多数癌症专科学会也建议患者及早接受姑息治疗。然而，尽管有强有力的证据基础和来自护理质量机构的支持，许多癌症患者，无论是在退伍军人事务部内外，都没有接受任何姑息治疗，或者在病程太晚时得到了姑息治疗，以至于无法认识到其全部好处。此外，肿瘤学家自己在多大程度上提供姑息治疗(初级姑息治疗)完全未知。这项提议旨在了解肿瘤学家对姑息治疗的看法，包括他们是否认为这是一项有用的服务，何时他们更愿意自己提供(初级姑息治疗)而不是转介给姑息治疗专家(二级姑息治疗)，以及他们认为姑息治疗的合适时机。这项建议还旨在了解肿瘤学家认为价值在为临终病人提供护理方面应该发挥的作用。在医疗保健中，价值表示患者结果的成就与为实现这些结果所花费的资源成正比。由于质量和成本都有助于这一定义，它避免了政治格局中普遍存在的常见陷阱，即将价值等同于简单的成本削减。评估癌症的价值可能很重要，原因有很多，其中最重要的是患者在接受癌症相关治疗后面临巨大的经济困难。然而，价值，尤其是成本，可能是一个有争议的话题；正因为如此，我们认为进行实证探索的时机已经成熟。此外，由于确定生命终结本身在肿瘤学家社区内正在辩论，我们借此机会询问肿瘤学家关于这一生命阶段的定义。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提案工作的结果，将提供重要的信息来源，可用于适当改善患者接受姑息治疗的情况，并提高以肿瘤学家为导向的价值策略的有效性。肿瘤学家都是姑息治疗的守门人，要么是因为他们自己提供姑息治疗，要么是让患者接受姑息治疗服务。他们还指导为他们的病人购买护理。了解他们对护理转移性癌症患者的态度是与临床医生合作确保患者接受高价值护理的关键一步，以最大限度地提高他们与健康相关的生活质量。