Community hospitals focus on advanced cancer care

6581 Background: Advanced cancer is a leading cause of death in the US. While treatments have improved, patients still report physical, emotional, and financial burdens associated with the disease. In order to improve cancer care, a comprehensive examination of unmet needs among patients, health care professionals, and other stakeholders is required to develop interventions that can improve patient outcomes, experience, and reduce healthcare spending. Methods: A national convenience sample of patients, families, caregivers, healthcare professionals, payer groups, and healthcare delivery systems who have experience with cancer care were selected for participation. A 10-question survey was administered to participants regarding their experiences with current cancer care. A novel combination of Grounded theory, Stanford d.school and bio-design needs-findings methodologies were used to assess and prioritize needs. Results: A total of 273 participants presented 99 unique needs over the study period. Needs were organized into five categories: 1. Monitor/Intervene Patient Clinical and Symptom Data 2. Shared Decision-Making 3. Best Practice Communication 4. Integrated Care Team 5. Patient-Tailored Care. The most common needs of cancer patients were improved symptom control. Needs among providers focused on minimizing tasks that could be performed by others. Payer needs reflected improved value in care. Family and caregiver needs reflected shared decision-making in treatment plans. Healthcare delivery system needs included improved guideline development, evidence-based care, and report of quality metrics. Conclusions: A novel methodology to assess, analyze, and organize unmet needs in cancer care reveals that the top concerns among stakeholders are better symptom control, enhanced efforts to improve patient care commensurate with patients’ values, and a more tailored approach to coordinate care delivery using guideline-based care with attention to quality metrics. Future studies should draw upon these needs to develop targeted interventions for patients with advanced cancer that can improve experience, clinical outcomes, and reduce healthcare spending.

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Using palliative care to maximize the value of care for patients with advanced cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.59 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 59-59

Author(s):

Risha Gidwani ◽

Randall Gale ◽

Diane E. Meier ◽

Steven M Asch

Keyword(s):

Palliative Care ◽

Patient Outcomes ◽

Advanced Cancer ◽

Cancer Care ◽

Financial Burden ◽

Medical Costs ◽

The United States ◽

Care Patient ◽

Care Needs ◽

Patients With Cancer

59 Background: Cancer is one of the highest cost conditions in the United States, with growth in cancer costs outpacing general medical costs. This is troubling from a patient perspective. Patients with cancer experience significantly greater financial burdens compared with patients with other medical conditions. Many patients forgo or discontinue cancer treatment partly because they do not want to burden their families with significant debt. The growth of cancer and other medical costs is also threatening the health of the U.S. economy, prompting calls for the need for high-value practices. In healthcare, value indicates an achievement of patient outcomes proportional to the resources spent to achieve them. Increasing the provision of palliative care may be one way to achieve higher value care in cancer. Methods: We summarize the literature regarding palliative care, patient outcomes, and costs to assess the value of palliative care in advanced cancer. We also review the literature to identify reasons for low patient receipt of palliative care. Results: Palliative care represents a strong opportunity to improve the value of cancer care. Palliative care is associated with better informed and more satisfied patients and families, a reduction in use of undesired medical services, and does not pose a risk of increased mortality. Reasons for low rates of palliative care include a mismatch between how patients perceive palliative care and how physicians believe patients perceive palliative care, a lack of familiarity with locally-available palliative services, and a perceived incompatibility with cancer therapy. Conclusions: Palliative care for patients with cancer can improve the patient and family experience while maximizing value for the healthcare system and averting unnecessary patient financial burden. Systems redesign is needed in order to support oncologists in supporting the palliative care needs of their patients and realizing this high-value cancer care.

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