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: 10654860
• 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/10654860
• 关键词: Adherence; Affect; Award; Awareness; Cancer Patient; Clinic; Clinical; Clinical Trials Design; Combined Modality Therapy; Data; Decision Making; Dedications; Development; Development Plans; Disparity; 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; 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; 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; patient oriented; 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.

项目摘要/摘要 候选人：黛博拉·凯，医学博士，医学硕士，泌尿外科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。凯博士的长期目标是成为一名独立的 外科医生-在定量和定性研究方法方面具有专业知识的科学家，对 提供商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：许多系统疗法最近已被批准用于治疗晚期糖尿病 前列腺癌，表明中位生存期从2个月到5个月略有改善。不幸的是， 关于哪种疗法或疗法的组合最有效，人们知之甚少。已知的是， 然而，每种方案在给药途径、副作用和价格上都有很大的不同。目前， 晚期前列腺癌的治疗因提供者的专业和地点以及患者的不同而有很大不同 种族和收入。由于比较有效性的证据很少，治疗建议严重依赖于 医生的偏好和经验，这可能有助于不同的患者结果和支付 差距。提供商决策的经济和非经济驱动因素仍然是 晚期前列腺癌。此外，几乎没有干预措施来减少自付费用，以及 因此，有可能改善晚期前列腺癌患者的预后。 具体目标：1)确定影响供应商进行系统初始选择决策的因素 晚期前列腺癌的治疗。2)开发成本透明的干预措施，以减少患者OOP 为前列腺癌的晚期治疗买单。3)进行可行性、可接受性、可用性和初步试验 成本透明干预有效的信号。 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，以降低患者的自付费用 支付和改善晚期前列腺癌患者的预后。最后，这项提案将考验 成本-透明度干预的可行性、可接受性、可用性和有效性的初步信号- ARM随机试点试验 职业发展计划：与概述的研究计划并行，并在有经验的指导下进行 在导师的指导下，凯博士将在以下方面发展专业知识：1)供应商决策；2)定性研究方法；3) 干预和临床试验设计。

项目成果

Drug costs: acquisition costs are critical but not the entire story of financial toxicity.

药品成本：采购成本至关重要，但并不是财务毒性的全部。

• DOI: 10.1111/bju.16092
• 发表时间: 2023
• 期刊: BJU international
• 影响因子: 4.5
• 作者: Kaye,DeborahR

Medication Payments by Insurers and Patients for the Treatment of Metastatic Castrate-Resistant Prostate Cancer.

保险公司和患者为治疗转移性去势抵抗性前列腺癌支付的药物费用。

• DOI: 10.1200/op.22.00645
• 发表时间: 2023
• 期刊: JCO oncology practice
• 影响因子: 4
• 作者: Kaye,DeborahR;Lee,Hui-Jie;Gordee,Alexander;George,DanielJ;Ubel,PeterA;Scales,CharlesD;Bundorf,MKate
• 通讯作者: Bundorf,MKate