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

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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.