Oncologists' Attitudes towards Treating Patients with Advanced Cancer

肿瘤科医生对治疗晚期癌症患者的态度

• 批准号: 8982942
• 负责人: Risha Gidwani Marszowski
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8982942
• 关键词: Achievement; Address; Advanced Malignant Neoplasm; American Society of Clinical Oncology; Area; Attitude; Behavior; Cancer Patient; Caring; Categories; Cessation of life; Communities; Disease; Disseminated Malignant Neoplasm; Effectiveness; Ensure; Exposure to; Face; Family; Future; Gatekeeping; Goals; Health; Health Benefit; Healthcare; Influentials; Institute of Medicine (U.S.); Institution; Interview; Investigator-Initiated Research; Life; Literature; Malignant Neoplasms; Medical; Medicine; Methods; National Comprehensive Cancer Network; Oncologist; Outcome; Palliative Care; Patient Care; Patients; Peer Review; Perception; Physicians; Pilot Projects; Planning Theory; Play; Quality of Care; Quality of life; Questionnaires; Research; Research Personnel; Research Proposals; Resources; Review Literature; Role; SEER Program; Sampling; Services; Societies; Solid Neoplasm; Source; Specialist; Staging; Structure; Surveys; Symptoms; System; Testing; Time; Treatment Cost; United States; Veterans; Work; Writing; base; cost; design; end of life; evidence base; experience; health related quality of life; improved; interest; medical specialties; oncology; palliative; stem; tumor

 DESCRIPTION (provided by applicant): The goal of this pilot proposal is to design a survey to elicit oncologists' attitudes towards treating patients with advanced cancer. Specifically, we wish to understand oncologists' attitudes in two main areas: 1) the role of palliative care in the treatment of any patient with metastatic cancer; and 2) the role, if any, of value in making treatment decisions for patients with metastatic solid tumors who are at the end-of-life (with end-of-life defined by interviewees). The ultimate purpose of this research is thus also twofold: a) to improve patient receipt of timely palliative care, a service that has been repeatedly shown to be of substantial benefit to patients with cancer; and b) to improve the effectiveness of oncologist-oriented value strategies. As this area of inquiry has been little studied in the peer-reviewed literature, and we endeavor to create a high- quality survey that cogently queries oncologists about their attitudes towards caring for patients with metastatic cancer, we begin by conducting semi-structured interviews to understand the domains and items oncologists feel are important in considering value and palliative care. We conduct qualitative analyses of these interviews and use results to inform design of a closed-ended survey. Our future goals include pre-testing this survey with oncologists, and writing a proposal to disseminate this survey to a large sample of oncologists nationwide. Our interest in understanding oncologists' attitudes towards palliative care for patients with metastatic cancer stems from the incongruence that currently exists between research and practice. There is a strong body of evidence indicating that palliative care improves quality of life and reduces symptoms for patients with cancer. The vast majority of cancer specialty societies also recommend early exposure to palliative care for patients. However, despite the strong evidence base and support from the quality-of-care establishment, many cancer patients, both within and outside of VA, do not receive any palliative care, or are provided palliative care so late in the course of disease they are not able to recognize its full benefit. Furthermore, the extent to which oncologists provide palliative care themselves (primary palliative care) is entirely unknown. This proposal aims to understand oncologists' perceptions of palliative care, including whether they consider it to be a useful service, when they prefer to provide it themselves (primary palliative care) versus refer out to palliative care specialists (secondary palliative care), and what they feel is the appropriate timing of palliative care. This proposal also aims to understand the role oncologists feel value should play in the provision of care for patients at the end-of life. In healthcare, value indicates an achievement of patient outcomes proportional to the resources spent to achieve them. As both quality and cost contribute to this definition, it avoids the common pitfall, prevalent in the political landscape, f equating value with simple cost cutting. Value in cancer can be important to evaluate for a number of reasons, not the least of which is the substantial financial difficulties patients face a a result of their cancer-related medical treatment. However, value, and in particular costs, can be a contentious topic; it is for this reason we feel it is ripe for empirical exploration. Additioally, as determining end-of-life itself is debated within the oncologist community, we take this opportunity to query oncologists about their definitions of this stage of life. We believe results from this pilot work, and from the larger proposal work this pilot study will inform, will provide ey sources of information that can be used to improve patients' receipt of palliative care as appropriate, and to improve the effectiveness of oncologist-oriented value strategies. Oncologists are both the gatekeepers to palliative care, either because they provide it themselves or refer patients to palliative care services. They also guide the purchasing of care for their patients. Understanding their attitudes towards caring for patients with metastatic cancer is a vital step in partnering with clinicians to ensure patients receive high-value care tha maximizes their health-related quality of life.

 描述（由申请人提供）： 该试点建议的目的是设计一项调查，以使肿瘤学家的与会者对患有晚期癌症患者进行治疗。具体来说，我们希望了解两个主要领域的肿瘤学家的参与者：1）姑息治疗在任何转移性癌症患者治疗中的作用； 2）在为处于终止终止的转移性实体瘤患者做出治疗决策（由受访者定义的生命终止）做出治疗决策中的作用（如果有的话）。 因此，这项研究的最终目的是双重的：a）提高患者及时收到 姑息治疗，这项服务反复证明对癌症患者具有很大的好处； b）提高面向肿瘤的价值策略的有效性。 As this area of​​ ​​inquiry has been little studiod in the peer-reviewed literature, and we endeavor to create a high-quality survey that cogently queries oncologists about their attendance towards caring for patients with metastatic cancer, we begin by conducting semi-structured interviews to Understand the domains and items oncologists feel are important in considering value and palliative care.我们对这些访谈进行定性分析，并使用结果为封闭调查的设计提供信息。我们未来的目标包括与肿瘤学家进行调查，并撰写一项提案，将这项调查传播给全国大量肿瘤学家。我们对了解肿瘤学家的参与者对转移性癌症患者进行姑息治疗的兴趣，从目前的研究和实践之间存在的不一致。有大量证据表明，姑息治疗可以改善生活质量并减少癌症患者的症状。绝大多数癌症专业协会还建议早期接触患者的姑息治疗。但是，在VA内外的许多癌症患者中，许多癌症患者都无法获得任何姑息治疗，或者在疾病过程中如此晚期提供姑息治疗，因此可以得到强大的证据基础和支持的证据基础和支持。此外，肿瘤学家本身提供姑息治疗的程度（初级姑息治疗）是完全未知的。该提案旨在了解肿瘤学家对姑息治疗的看法，包括当他们希望自己提供（主要的姑息治疗）而不是指姑息治疗专家（次要姑息治疗）时，他们认为它是否是有用的服务，以及他们认为他们认为是适当的姑息治疗时机。该提案还旨在了解肿瘤学家认为在为患者提供护理时的角色应发挥的作用。在医疗保健中，价值表明可以实现与实现这些成果成正比的患者结局。由于质量和成本都有助于这一定义，因此它避免了在政治景观中普遍存在的共同陷阱，将价值等同于简单的成本削减。出于多种原因评估癌症的价值可能很重要，其中最重要的是，患者面临与癌症相关的医疗所面临的重大财务困难。但是，价值，特别是成本可能是一个有争议的话题。正是由于这个原因，我们认为它已经成熟了经验探索。从添加剂上讲，由于确定寿命本身在肿瘤学家社区中进行了辩论，我们借此机会询问肿瘤学家对他们对这一生命的定义的定义。我们认为，这项试点工作的结果，并且从更大的提案工作中，该试点研究将告知，将提供信息源，可用于改善患者适当地收到姑息治疗，并提高面向肿瘤学家的价值策略的有效性。肿瘤学家既是姑息治疗的守门人，要么是因为他们自己提供它，要么将患者推荐给姑息治疗服务。他们还指导为患者购买护理。了解他们参加转移性癌症患者的出席是与临床医生合作的重要一步，以确保患者获得高价值护理，从而最大程度地提高了与健康相关的生活质量。