Examining the multilevel factors on quality of end-of-life care among cancer patients in Puerto Rico

检查影响波多黎各癌症患者临终关怀质量的多层次因素

• 批准号: 10557584
• 负责人: KAREN J ORTIZ
• 金额: $ 23.35万
• 依托单位: UNIVERSITY OF PUERTO RICO MED SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10557584
• 关键词: Advance Care Planning; Advanced Malignant Neoplasm; Affect; Aging; Attitude; Behavior; Breast; Cancer Burden; Cancer Center Planning Grant; Cancer Patient; Cancer health equity; Caregivers; Caring; Cause of Death; Characteristics; Clinical; Communication; Complex; Consultations; Coupled; Cross-Sectional Studies; Data; Data Analytics; Data Collection; Databases; Decision Making; Development; Diagnosis; Disparity; Disparity population; Economic Burden; Emergency department visit; Enrollment; Family; Future; Goals; Gynecologic; Health Insurance; Healthcare Systems; Hematologist; Hispanic; Hospice Care; Hospitalization; Incidence; Inequity; Inpatients; Insurance; Insurance Coverage; Intervention; Investigation; Knowledge; Life; Low income; Lung; Malignant Neoplasms; Oncologist; Outcome; Pain management; Palliative Care; Palliative Medicine; Patient Care; Patients; Pattern; Persons; Phase; Physicians; Population; Poverty; Privatization; Procedures; Process; Prognosis; Prostate; Provider; Puerto Rican; Puerto Rico; Quality of Care; Quality of life; Recommendation; Series; Surveys; System; Testing; Time; Training; United States; Variant; aging population; cancer care; care costs; cost; cost comparison; cost effective; effective intervention; end of life; end of life care; gastrointestinal; health care delivery; hospice environment; improved; leukemia; male; malignant mouth neoplasm; medical specialist; mortality; neoplasm registry; opioid use; participant enrollment; preference; randomized trial; sociodemographics

PROJECT SUMMARY/ABSTRACT In the United States (US) and Puerto Rico (PR), cancer is the second leading cause of death. Considering that the population is aging, an increase in the burden of cancer is expected in future years. Consequently, quality of care at the end of life (EoL) is critical for dying cancer patients and their families. Studies in the US have shown that EoL care is expensive for cancer patients and frequently has very low or no clinical value, and often is inconsistent with the patient's needs, values, and preferences. Conversely, timely receipt of palliative and hospice care can improve quality of life and decrease emergency department visits, hospitalizations, and the use of life-extending procedures. Even when progress is made towards improving the quality of EoL care, a growing body of evidence shows disparities among groups within the population. Understanding the different characteristics that affect the quality of care at the EoL is fundamental to implementing effective interventions to reduce inequity and improve the efficiency of the healthcare delivery system. There are few studies in the US and no study in PR evaluating the quality of EoL care from the multilevel perspective. This proposal would be the first of such a series of investigations. PR has a predominantly Hispanic, low-income, and aging population with high insurance coverage. Forty-eight percent of the PR population lives below the poverty level, and there is a shortage of medical specialists, including palliative medicine. This study provides an opportunity to investigate the variations in the use of recommended care, its cost, and the provider and patient's behaviors towards EoL decisions. This study seeks to advance our knowledge and understanding of EoL care among cancer patients by utilizing state-of- the-art claims data analytics coupled with surveys data collection. Towards this effort, we will merge the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database with CMS hospice claims data and conduct physicians, patients, and caregivers’ surveys. Specific Aims are: 1) Assess the use of recommended care and the cost of care among cancer patients nearing EoL in PR; 2) Examine the perceived barriers to EoL discussion and decision-making process among oncologists in PR; and 3) Determine the knowledge, attitudes, and EoL planning among cancer patients and their caregivers in PR. This study will provide new evidence that will help us understand the complex process of EoL care and how different factors interact. Our most important contribution will be to document the potential multilevel influences on EoL care. This information will be essential for developing and implementing a multilevel intervention to improve the quality of care at the EoL. We expect our results can help improve health care delivery and enhance cancer patients' overall quality of life in a cost-effective way.

项目概要/摘要 在美国 (US) 和波多黎各 (PR)，癌症是第二大死因。 人口老龄化，预计未来几年癌症负担将会增加。 美国的研究表明，临终关怀（EoL）对于垂死的癌症患者及其家人至关重要。 研究表明，临终关怀对于癌症患者来说是昂贵的，并且通常临床价值非常低或没有临床价值，而且通常 线下不符合患者的需求、价值观和偏好，及时接受姑息治疗。 临终关怀可以改善生活质量并减少急诊就诊、住院和住院治疗 即使在提高临终护理质量方面取得了进展， 越来越多的证据表明，不同群体之间的理解存在差异。 影响 EoL 护理质量的特征是实施有效干预措施的基础 减少不平等并提高医疗保健服务系统的效率的研究很少。 美国并没有 PR 研究从多层次的角度评估 EoL 护理的质量。 这是一系列调查中的第一个，主要针对西班牙裔、低收入和老龄化人群。 保险覆盖率高的人群。 48%的PR人口生活在贫困线以下，医疗资源短缺 专家，包括姑息医学，这项研究提供了一个研究变化的机会。 推荐护理的使用、其成本以及提供者和患者对 EoL 决策的行为。 旨在通过利用现状来提高我们对癌症患者临终关怀的认识和理解 为了实现这一目标，我们将把最先进的索赔数据分析与调查数据收集相结合。 Rico 中央癌症登记处-包含 CMS 临终关怀索赔数据和行为的健康保险链接数据库 医生、患者和护理人员的调查具体目标是： 1) 评估推荐护理的使用情况和 PR 中接近 EoL 的癌症患者的护理费用；2) 检查 EoL 的感知障碍； 肿瘤学家在 PR 中的讨论和决策过程；以及 3) 确定知识、态度、 癌症患者及其护理人员的生命终止规划这项研究将提供新的证据： 将帮助我们了解 EoL 护理的复杂过程以及不同因素如何相互作用。 贡献将是记录对 EoL 护理的潜在多层次影响。 这些信息对于制定和实施多层次干预措施以改善 我们希望我们的结果能够帮助改善医疗保健服务并增强癌症治疗的质量。 以具有成本效益的方式提高患者的整体生活质量。