Trends in the cost of the futile cancer care near the end of life.

126 Background: Aggressive cancer care near the end of life may not only represent a quality-of-care issue, but also a futility issue. Under the constraint of health resources, it is of interest to know the cost trends of futile treatment for cancer patients near the end of their life. Methods: The definition of potential medical futility for cancer patients near the end of their life was developed based on the RAND/UCLA Appropriateness Method. Nine experts or academics from medical, political, social, or legal fields built a consensus that treatment after 7 days in the intensive care unit following a cardiopulmonary resuscitation for cancer patients who died within 3 months is probably futile. Based on this definition, we used death registry and Taiwan’s National Health Insurance claim data from 2000-2001 and 2009-2010 respectively to estimate the cost of potential futile treatment for cancer patients near the end of their life in 2001 and 2010. Results: The percentage of cancer patients receiving potentially futile treatment near the end of their life reduced from 2.68% in 2001 (883/32,993) to 1.58% in 2010 (649/41,046). The cost of potentially futile cancer care also decreased from $283 million NTD (New Taiwan Dollar) in 2001 to $255 million NTD in 2010 (1USD=30NTD). Nevertheless, the per capita cost of potentially futile cancer care slightly increased from $320 thousand NTD to $393 thousand NTD. Conclusions: Although the cost of potentially futile cancer care for patients near the end of life is not huge in Taiwan, its trend of decrease may indicate that supportive but not aggressive cancer care is more and more prevailing and acceptable by patients, their family, as well as health care providers.

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Delivering End-of-Life Cancer Care: Perspectives of Providers

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909117719879 ◽

2017 ◽

Vol 35 (3) ◽

pp. 497-504 ◽

Cited By ~ 14

Author(s):

Manali I. Patel ◽

Vyjeyanthi S. Periyakoil ◽

David Moore ◽

Andrea Nevedal ◽

Tumaini R. Coker

Keyword(s):

End Of Life ◽

Health Care Providers ◽

Cancer Care ◽

Care Delivery ◽

Comparative Method ◽

The United States ◽

Home Delivery ◽

Care Providers ◽

Face To Face ◽

Care Services

Objectives: Persistent gaps in end-of-life cancer care delivery and growing associated expenditures remain imminent US public health issues. The objective of this study was to understand clinical providers’ experiences delivering cancer care for patients at the end of life and their perspectives on potential solutions to improve quality of care. Methods: Semistructured interviews were conducted with 75 cancer care providers across the United States. The interviews were recorded, transcribed, and analyzed using constant comparative method of qualitative analysis. Results: Providers identified 3 major cancer care delivery challenges including lack of time to educate patients and caregivers due to clinical volume and administrative burdens, ambiguity in determining both prognosis and timing of palliative care at the end-of-life, and lack of adequate systems to support non-face-to-face communication with patients. To address these challenges, providers endorsed several options for clinical practice redesign in their settings. These include use of a lay health worker to assist in addressing early advance care planning, proactive non-face-to-face communication with patients specifically regarding symptom management, and community and in-home delivery of cancer care services. Discussion: Specific strategies for cancer care redesign endorsed by health-care providers may be used to create interventions that can more efficiently and effectively address gaps in end-of-life cancer care.

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Prevalence of written advance directives (AD) among cancer care providers at a community-based cancer center

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.18563 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 18563-18563

Author(s):

B. A. Hammes ◽

J. A. Lee ◽

M. A. Mathiason ◽

M. T. Ertz ◽

L. L. Sheldon ◽

...

Keyword(s):

End Of Life ◽

Health Care Providers ◽

Nurse Practitioners ◽

Cancer Care ◽

Medical Condition ◽

Cancer Center ◽

Care Providers ◽

Community Based ◽

Life Planning ◽

End Of Life Planning

18563 Background: Cancer care providers frequently discuss AD with their patients. The providers’ own attitudes toward end-of-life planning likely influence the choices and actions of their patients. We investigated the prevalence of written AD among the care providers at our community-based cancer center. Methods: All cancer center employees who have face-to-face contacts with patients (N=170) were sent an email survey in October 2005. This included medical (physicians, 15), associate (physician assistants and nurse practitioners, 7), and support (nurses, radiation therapists, medical or nurse assistants, and patient liaisons; 148) staffs. We collected data on demographics, work history, and AD. Results: A reply was obtained from 136 (80%) individuals. There were more females (90.2%) and the median age was 43 years (range, 20–63). While 82.8% reported to have discussed their wishes regarding future life-sustaining medical care with those closest to them, only 35.1% had a written AD: medical (58.3%), associate (50%), and support staffs (32.2%). Among those with AD, only 66% had made their own care providers aware of this. The top 5 factors that influenced providers whether to have or not to have AD were: experience at work (36.6%), spouse/domestic partner (25.4%), time to complete written AD (23.9%), family members/friends (21.6%) and children (19.4%). Interestingly, no one considered medical condition or illness as a factor. Increased age was significantly associated with having AD (odds ratio: 1.068; 95% CI:1.029–1.108), while the sex, number of years working with cancer patients, provider role, and marital/living status were not. Among the medical and associate staffs, 55.6% reported routinely discussing AD with their patients. Although all medical/associate staffs rated themselves as knowledgeable about and comfortable with discussing AD, the group who had AD was more apt to rate themselves as very knowledgeable and very comfortable. Conclusions: Only about a third of all cancer care providers and about half of cancer physicians at our institution have a written AD. Despite work experience with a patient population having a high mortality rate, cancer care providers do not adequately communicate end-of-life planning to their own health care providers. No significant financial relationships to disclose.

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Fear of receiving less effective care: A barrier to effective cancer care cost communication.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18339 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18339-e18339

Author(s):

Sokbom Kang ◽

Yelee Yu

Keyword(s):

Effective Treatment ◽

Cancer Patients ◽

Cancer Care ◽

Financial Burden ◽

Considerable Proportion ◽

Care Providers ◽

Financial Status ◽

Cost Effective Treatment ◽

The Cost ◽

To Receive

e18339 Background: Increasing financial burden in cancer care promoted cost communication as an intervention to the problem. We explored patients’ attitudes and concerns for the physician-patient communication of the costs of cancer care. Methods: From an oncology outpatient clinic, patients were recruited and interviewed using a 29-item questionnaire. The questionnaire includes basic and financial characteristics, attitudes toward cost-communication, and experience of cost-communication with oncologists. Results: Among 292 patients with gynecologic cancer, 68% were found to have an income below the nation’s average households income. Although the majority (81%) of patients have a positive attitude toward patient-physician cancer care cost-communication, however, only 19% of them wanted to discuss the cost with their physicians - 33% of them did not want to disclose their financial status to health care providers and 48% wanted to discuss the cost with other providers than their physicians. In addition, while 87% preferred to be informed about costs for various treatment options, 86% of them did not want to receive cost-effective treatment and preferred to receive the most effective treatment regardless of their financial status. Compared with non-cancer patients (n = 83), significantly more patients had a negative attitude to disclosing their financial status especially to their physician (22% vs. 11%, P = 0.024). Conclusions: A considerable proportion of cancer patients had concerns that cost communication with their physician may interfere with their opportunity to access the best care options. To facilitate cost communication, oncologists should understand such concerns and making a thoughtful effort to relieve the concern during cost communication.

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The role of family physicians in cancer care: perspectives of primary and specialty care providers

Current Oncology ◽

10.3747/co.24.3447 ◽

2017 ◽

Vol 24 (2) ◽

pp. 75 ◽

Cited By ~ 21

Author(s):

J. Easley ◽

B. Miedema ◽

M.A. O'Brien ◽

J. Carroll ◽

D. Manca ◽

...

Keyword(s):

Health Care ◽

Cancer Patients ◽

Health Care Providers ◽

Cancer Care ◽

Psychosocial Care ◽

Family Physicians ◽

Further Education ◽

Theory Approach ◽

Care Providers

Background Currently, the specific role of family physicians (fps) in the care of people with cancer is not well defined. Our goal was to explore physician perspectives and contextual factors related to the coordination of cancer care and the role of fps.Methods Using a constructivist grounded theory approach, we conducted telephone interviews with 58 primary and cancer specialist health care providers from across Canada.Results The participants—21 fps, 15 surgeons, 12 medical oncologists, 6 radiation oncologists, and 4 general practitioners in oncology—were asked to describe both the role that fps currently play and the role that, in their opinion, fps should play in the future care of cancer patients across the cancer continuum. Participants identified 3 key roles: coordinating cancer care, managing comorbidities, and providing psychosocial care to patients and their families. However, fps and specialists discussed many challenges that prevent fps from fully performing those roles:The fps described communication problems resulting from not being kept “in the loop” because they weren’t copied on patient reports and also the lack of clearly defined roles for all the various health care providers involved in providing care to cancer patients.The specialists expressed concerns about a lack of patient access to fp care, leaving specialists to fill the care gaps.The fps and specialists both recommended additional training and education for fps in survivorship care, cancer screening, genetic testing, and new cancer treatments.Conclusions Better communication, more collaboration, and further education are needed to enhance the role of fps in the care of cancer patients.

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Cost of Cancer Care: The Patient Perspective

Journal of Clinical Oncology ◽

10.1200/jco.2006.07.9111 ◽

2007 ◽

Vol 25 (2) ◽

pp. 228-232 ◽

Cited By ~ 71

Author(s):

Paula Kim

Keyword(s):

Health Care ◽

Health Care Providers ◽

Cancer Care ◽

Patient Perspective ◽

Indirect Costs ◽

Care Providers ◽

Limited Ability ◽

Patient Advocates ◽

Diagnosis Of Cancer ◽

The Cost

The diagnosis of cancer, along with subsequent related care, imposes a number of burdens on patients—physical, emotional, and financial. The financial expenses incurred extend well beyond the cost of medication, surgery, and related treatments. While these important issues warrant attention, patients also need assistance dealing with the indirect costs of cancer care, such as transportation, child care, and lost wages. There is an urgent need to improve the current inconsistent—sometimes nonexistent—methods used to inform patients about costs of cancer care as well as to provide them with appropriate assistance managing the costs and overall burden of cancer. Health care providers, patient advocates, agencies, and insurers have the responsibility and opportunity to provide leadership in this process. Most importantly, limited ability to address any of the expenses brought on by cancer should not prevent any patient from receiving necessary care.

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Fear of receiving less effective care: A barrier to effective cancer care cost communication.

Journal of Global Oncology ◽

10.1200/jgo.2019.5.suppl.8 ◽

2019 ◽

Vol 5 (suppl) ◽

pp. 8-8

Author(s):

Sokbom Kang ◽

Ye Lee Yu

Keyword(s):

Effective Treatment ◽

Cancer Patients ◽

Cancer Care ◽

Financial Burden ◽

Considerable Proportion ◽

Care Providers ◽

Financial Status ◽

Cost Effective Treatment ◽

The Cost ◽

To Receive

8 Background: Increasing financial burden in cancer care promoted cost communication as an intervention to the problem. We explored patients’ attitudes and concerns for the physician-patient communication of the costs of cancer care. Methods: From an oncology outpatient clinic, patients were recruited and interviewed using a 29-item questionnaire. The questionnaire includes basic and financial characteristics, attitudes toward cost-communication, and experience of cost-communication with oncologists. Results: Among 292 patients with gynecologic cancer, 68% were found to have an income below the nation’s average households income. Although the majority (81%) of patients have a positive attitude toward patient-physician cancer care cost-communication, however, only 19% of them wanted to discuss the cost with their physicians - 33% of them did not want to disclose their financial status to health care providers and 48% wanted to discuss the cost with other providers than their physicians. In addition, while 87% preferred to be informed about costs for various treatment options, 86% of them did not want to receive cost-effective treatment and preferred to receive the most effective treatment regardless of their financial status. Compared with non-cancer patients (n = 83), significantly more patients had a negative attitude to disclosing their financial status especially to their physician (22% vs. 11%, P = 0.024). Conclusions: A considerable proportion of cancer patients had concerns that cost communication with their physician may interfere with their opportunity to access the best care options. To facilitate cost communication, oncologists should understand such concerns and making a thoughtful effort to relieve the concern during cost communication.

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Environmental Stressors Suffered by Women with Gynecological Cancers in the Aftermath of Hurricanes Irma and María in Puerto Rico

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111183 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11183

Author(s):

Pablo A. Méndez-Lázaro ◽

Yanina M. Bernhardt ◽

William A. Calo ◽

Andrea M. Pacheco Díaz ◽

Sandra I. García-Camacho ◽

...

Keyword(s):

Puerto Rico ◽

Cancer Patients ◽

Health Care Providers ◽

Cancer Care ◽

The United States ◽

Climate Impacts ◽

Environmental Stressors ◽

Decision Makers ◽

Care Providers ◽

The Caribbean

Background: Hurricanes are the immediate ways that people experience climate impacts in the Caribbean. These events affect socio-ecological systems and lead to major disruptions in the healthcare system, having effects on health outcomes. In September 2017, Puerto Rico (PR) and the United States Virgin Islands (USVI) experienced one of the most catastrophic hurricane seasons in recent history (Hurricane Irma was a Category 5 and Hurricane María was a Category 4 when they hit PR). Objective: This study examines environmental stressors experienced by women with gynecologic (GYN) cancers from PR and USVI who received oncologic cancer care in PR, in the aftermath of the hurricanes. Methods: A descriptive qualitative study design was used to obtain rich information for understanding the context, barriers, knowledge, perspectives, risks, vulnerabilities, and attitudes associated to these hurricanes. We performed focus groups among GYN cancer patients (n = 24) and key-informant interviews (n = 21) among health-care providers and administrators. Interviews were conducted from December 2018–April 2019. Results: Environmental health stressors such as lack of water, heat and uncomfortable temperatures, air pollution (air quality), noise pollution, mosquitos, and rats ranked in the top concerns among cancer patients and key-informants. Conclusions: These findings are relevant to cancer patients, decision-makers, and health providers facing extreme events and disasters in the Caribbean. Identifying environmental secondary stressors and the most relevant cascading effects is useful for decision-makers so that they may address and mitigate the effects of hurricanes on public health and cancer care.

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Digital Solutions for Cancer Survivorship Care (Preprint)

10.2196/preprints.11717 ◽

2018 ◽

Author(s):

Ingrid Oakley-Girvan ◽

Sharon Watkins Davis ◽

Michelle Longmire

Keyword(s):

Health Care ◽

Activities Of Daily Living ◽

Cancer Patients ◽

Health Care Providers ◽

Care Coordination ◽

Cancer Care ◽

Daily Living ◽

Informal Caregivers ◽

Survivorship Care ◽

Care Providers

BACKGROUND Both the National Cancer Institute (NCI) and Institute of Medicine have stressed the importance of survivorship care plans (SCP) for cancer patients/survivors and discussed the significance and importance of required input from survivors and advocates. However, there are many barriers to cancer care coordination and the creation of SCPs, including oncology staff time required to write them. Although survivors valued SCPs and liked them, few survivors or caregivers report receiving survivorship information and in some studies, reported no receipt of an SCP. Digital platforms can support cancer survivorship care by integrating with the existing Electronic Health Record and presenting information in a dynamic and user-friendly format that improves coordination and communication. OBJECTIVE In this paper, we describe our involvement of stakeholders, including medical staff, patients/survivors and informal caregivers in developing a user-centered design for TOGETHERCARE, a smartphone app envisioned to provide critical functionality including planning and sharing of the SCP among survivors, physicians, and informal caregivers. METHODS Two interviewers conducted a total of nine semi-structured interviews, including a convenience sample of three health care providers who work with cancer patients, three cancer patients/survivors, and three informal caregivers currently caring for cancer patients/survivors. The interviews with Spanish-speaking patients/survivors and caregivers were conducted with a translator. Notes from the interviews were transcribed into a prepared template. The results were compiled and coded by two members of the core team. RESULTS We identified areas of consistency in responses between the three different groups in terms of how the application should work, as well as areas of difference. Additional suggestions for features for the application are also presented. Health care providers focused on the efficiency of using the application, features that would improve follow-up visits with patients and reduce the nursing triage, ER visits and readmissions. Survivors and caregivers were more focused on features that would provide assistance with patient appointment schedules, at-home medical tasks and activities of daily living. Although all three groups agreed that there is currently no systematic way for specialists to keep in touch with patients once they have moved to community care, and that SCPs would be useful, the practice of providing SCPs is rarely implemented. Survivors, caregivers, and providers all agreed that they have smartphones and that an app that includes the ability to communicate between the different groups, along with other features such as guidance on assisting with daily medical tasks and activities of daily living would be useful. CONCLUSIONS The pervasiveness of mobile devices and mobile app use provides an opportunity to make survivorship information and plans more readily available to caregivers and survivors, and to incorporate patient outcome reporting. Health care providers, cancer survivors, and informal caregivers all responded positively to a variety of features that could improve the efficiency of cancer care coordination and dynamic SCP provision.

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