Improving The Quality Of Advanced Cancer Care With Disease Management

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DESCRIPTION (provided by applicant): Patients with advanced stage cancer have need for access to both cure-oriented therapies and palliation. The National Comprehensive Cancer Network (NCCN) identifies the goal of palliative care as the prevention and relief of suffering regardless of the stage of disease and regardless of whether palliative care is provided concurrently with life-prolonging care or as the main focus of care. Despite recognition of the importance of symptom management expertise and attention to the psychosocial aspects of the cancer experience, patients continue to identify shortcomings in palliative care and end-of-life care, including lack of coordination and communication, difficulty accessing care, inadequate symptom management, and prolongation of the dying process. Significant improvements require changes in the care delivery system in order to assure that: (a) patients have access to expert management of physical, psychological, and spiritual needs as well as excellent curative therapy (b) families of patients receive the same expert support; (c) access to professionals who have the skills and time to assist patients and their families make the transition from a primary goal of cure to a primary goal of palliation is readily available; and (d) a coordinated transition to community providers, such as home care, palliative care programs, and hospice occurs. There is growing evidence that disease management is a care delivery model that is able to specifically address these needs, although it has never been tested in an academic cancer center. The purpose of this investigation is to implement a comprehensive disease management program (DMP) and measure effects on quality of life and quality of care of advanced cancer patients and their families, and to examine the effects on resource use. A two-group, quasi-experimental, tandem enrollment design will be used. Research questions are: (1) Is there a difference in resource use (number of chemotherapy treatments in the last 30 days of life, number of emergency room visits, number of days of hospice and hospitalization) among patients with advanced cancer who have participated in a DMP compared to those receiving usual care? (2) Is there a difference in patient outcomes (health related quality of life, spiritual well being, satisfaction with care) among patients with advanced cancer who have participated in a DMP compared to those receiving usual care? (3) Is there a difference in caregiver outcomes (mood state, satisfaction with care, satisfaction with end of life care, and burden of caregiving) among caregivers of patients with advanced cancer who have participated in a DMP compared to those receiving usual care? (4) Do the differences in patient and caregiver outcomes remain after controlling for the influence of demographic, clinical and organizational covariates? (5) To what extent are differences in patient and caregiver outcomes achieved through improvements in collaboration and problem solving?