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.

项目总结/摘要 候选人：Deborah Kaye，MD，MS是泌尿肿瘤学家和初级卫生服务研究员，专注于 改善癌症患者的预后。凯伊博士的长期目标是成为一名独立的 外科医生，科学家与定量和定性研究方法的专业知识，深入了解 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，以改善癌症患者的生活。 研究背景：许多系统性治疗最近已被批准用于治疗晚期 前列腺癌，中位生存期从2个月到5个月有适度的改善。不幸的是， 关于哪种疗法或疗法的组合最有效知之甚少。已知的， 然而，每种选择在给药途径、副作用和价格上都有很大不同。目前， 晚期前列腺癌的治疗根据提供者的专业和地点以及患者的 种族与收入由于缺乏比较有效性的证据，治疗建议在很大程度上依赖于 医生的偏好和经验，这可能导致不同的患者结果和支付 差距。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，几乎没有干预措施来减少自付费用， 因此可能改善晚期前列腺癌患者的预后。 具体目的：1）确定影响供应商决策的因素，以初步选择系统性 治疗晚期前列腺癌。2)制定成本透明干预措施，以减少患者OOP payments付款for advanced先进prostate前列腺癌treatment治疗. 3)对可行性、可接受性、可用性和初始 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接受的一线全身治疗的类型，以及 使用迭代干预设计来设计成本透明干预，以降低患者自付费用 前列腺癌的治疗方法有哪些？最后，该提案将测试 成本透明度干预的可行性、可接受性、可用性和初步功效信号， 随机对照试验 职业发展计划：与概述的研究计划并行，并在经验丰富的 Kaye博士将在以下方面发展专业知识：1）提供者决策; 2）定性研究方法; 3） 干预和临床试验设计。