Improving outcomes of patients with advanced prostate cancer through a better understanding of provider decision-making

通过更好地了解医疗服务提供者的决策来改善晚期前列腺癌患者的治疗结果

• 批准号: 10525118
• 负责人: Deborah R. Kaye
• 金额: $ 14.48万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10525118
• 关键词: Adherence; Affect; Award; Awareness; Cancer Patient; Clinic; Clinical; Clinical Trials Design; Combined Modality Therapy; Data; Decision Making; Development; Development Plans; Economics; Ensure; Financial Hardship; Financial cost; Focus Groups; Foundations; Goals; Guidelines; Health Policy; Health Services; Income; Insurance Carriers; Intervention; Intervention Trial; Interview; Knowledge; Location; Malignant Neoplasms; Malignant neoplasm of prostate; Mentors; Nurses; Oncologist; Outcome; Outpatients; Patient Care; Patient Preferences; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Pharmacists; Physicians; Policies; Price; Process; Prostate; Prostate Cancer therapy; Provenge; Provider; Qualitative Methods; Qualitative Research; Race; Randomized; Randomized Controlled Trials; Recommendation; Research; Research Methodology; Research Personnel; Review Literature; Route; Scientist; Signal Transduction; Social Workers; Southeastern United States; Surgeon; Surveys; Systemic Therapy; Testing; Treatment outcome; Work; acceptability and feasibility; advanced prostate cancer; arm; base; cancer care; care providers; career; career development; clinical infrastructure; comparative effectiveness; cost; cost outcomes; design; docetaxel; experience; feasibility testing; financial toxicity; improved; improved outcome; informant; intervention refinement; iterative design; medical specialties; medication compliance; payment; pilot test; pilot trial; preference; provider behavior; rural area; side effect; therapy design; urban area; urologic; usability

PROJECT SUMMARY/ABSTRACT Candidate: Deborah Kaye, MD, MS is a urologic oncologist and junior health services researcher focused on improving the outcomes for patients with cancer. Dr. Kaye’s long-term goal is to become an independent surgeon-scientist with expertise in quantitative and qualitative research methods, an in- depth understanding of provider decision-making and intervention and clinical trial design, in order to devise, evaluate and implement effective health care policies to improve the lives of patients with cancer. Research Context: Numerous systemic therapies have recently been approved for the treatment of advanced prostate cancer, demonstrating modest improvements in median survival fromtwo to five months. Unfortunately, little is known regarding which therapies, or combinations of therapies, are most effective. What is known, however, is that each option differs significantly in route of administration, side effects, and price. Currently, treatment for advanced prostate cancer varies significantly based on provider specialty and location, and patient race and income. With sparse comparative effectiveness evidence, treatment recommendations rely heavily on physician preference and experience, which likely contributes to differential patient outcomes and payment disparities. Economic and non-economic drivers of provider decision-making remain a critical knowledge gap in advanced prostate cancer. Moreover, few interventions exist to decrease the out-of-pocket payments, and therefore potentially improve outcomes for patients with advance prostate cancer. Specific Aims: 1) To determine the factors contributing to provider decision-making for initial choice of systemic therapy for advanced prostate cancer. 2) To develop a cost-transparency intervention to decrease patient OoP payments for advanced prostate cancertreatment. 3) To pilot test the feasibility, acceptability, usability and initial signals of efficacy of a cost-transparency intervention. Research Plan: Dr. Kaye will use qualitative research methods (focus groups, patient and provider interviews) to determine the factors impacting provider decision-making and type of first-line systemic therapy received, and use iterative intervention design to devise a cost-transparency intervention to lower patient out-of-pocket payments and improve outcomes for patients with advanced prostate cancer. Finally, this proposal will test the feasibility, acceptability, usability and initial signals of efficacy of the cost-transparency intervention with a two- arm randomized pilot trial Career Development Plan: In parallel with the outlined research plan and under the guidance of experienced mentors, Dr. Kaye will develop expertise in: 1) provider decision-making; 2) qualitative research methods; 3) intervention and clinical trial design.

项目概要/摘要 候选人：黛博拉·凯 (Deborah Kaye)，医学博士、理学硕士，是一位泌尿肿瘤学家和初级卫生服务研究员，专注于 改善癌症患者的治疗结果。凯博士的长期目标是成为一名独立的 具有定量和定性研究方法专业知识的外科医生科学家，对 提供者决策和干预以及临床试验设计，以便设计、评估和实施 有效的医疗保健政策可改善癌症患者的生活。 研究背景：许多全身疗法最近已被批准用于治疗晚期 前列腺癌，中位生存期从两到五个月略有改善。很遗憾， 关于哪种疗法或疗法组合最有效，人们知之甚少。据了解， 然而，每种选择在给药途径、副作用和价格方面都存在显着差异。现在， 晚期前列腺癌的治疗根据提供者的专业、地点以及患者的不同而有很大差异 种族和收入。由于比较有效性证据很少，治疗建议很大程度上依赖于 医生的偏好和经验，这可能会导致不同的患者结果和付款 差异。供应商决策的经济和非经济驱动因素仍然是一个关键的知识差距 晚期前列腺癌。此外，很少有干预措施可以减少自付费用，并且 因此可能会改善晚期前列腺癌患者的预后。 具体目标： 1) 确定对系统提供商初始选择决策有贡献的因素 晚期前列腺癌的治疗。 2) 制定成本透明的干预措施以减少患者 OoP 晚期前列腺癌治疗的付款。 3) 试点测试可行性、可接受性、可用性和初步效果 成本透明度干预措施的有效性信号。 研究计划：Kaye 博士将使用定性研究方法（焦点小组、患者和提供者访谈） 确定影响提供者决策的因素和所接受的一线系统治疗的类型，以及 使用迭代干预设计来设计成本透明的干预措施，以降低患者的自付费用 付款并改善晚期前列腺癌患者的治疗结果。最后，该提案将测试 成本透明度干预措施的可行性、可接受性、可用性和初步有效性信号 手臂随机试验 职业发展计划：与概述的研究计划并行并在经验丰富的指导下 在导师的指导下，Kaye 博士将发展以下方面的专业知识：1) 提供者决策； 2）定性研究方法； 3） 干预和临床试验设计。