Patient preferences for provider roles in collaborative breast cancer survivorship care.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 184-184
Author(s):  
Lauren P. Wallner ◽  
Paul Abrahamse ◽  
Christopher Ryan Friese ◽  
Steven J. Katz ◽  
Sarah T. Hawley
Keyword(s):  
Breast Cancer ◽  
Los Angeles ◽  
Preventive Care ◽  
Patient Preferences ◽  
Cancer Care ◽  
Multinomial Logistic Regression ◽  
Physical Symptoms ◽  
Current Response ◽  
Survivorship Care ◽  
Emotional Symptoms

184 Background: Prior studies have exploredbarriers to collaborative cancer care and suggest a need for greater clarity about clinician roles. However, little is known about patient’s preferences and expectations for which clinicians handle various aspects of care after primary cancer treatment. Methods: A weighted random sample of newly diagnosed breast cancer patients in the Georgia and Los Angeles SEER registries were surveyed approximately 6 months after diagnosis (expected final N = 2600, 70% current response rate). Patient preferences for which clinician handles the following aspects of care after treatment were ascertained: follow-up mammograms, screening for other cancers, general preventive care, treatment of comorbidities, physical symptoms, emotional symptoms, and reassurance about their breast cancer. Response categories included primary care clinician (PCP), cancer doctors, either or both. The associations between patient demographic and clinical factors with preferences for clinician roles were assessed using multinomial logistic regression. Results: In a preliminary sample (N = 1038), the majority of women preferred to see oncologists for mammograms (63%), other cancer screening (67%) and reassurance about their cancer (75%) and PCPs for general preventive care (80%), comorbid care (85%) and emotional symptoms (67%). Black women (vs. White) were more likely to prefer to see both clinicians for mammograms (OR: 3.7, 95%CI: 2.5, 5.5), screening for other cancers (OR: 2.1, 95%CI: 1.3, 3.2), reassurance about their cancer (OR: 2.1, 95%CI: 1.3, 3.2), and general preventive care (OR: 4.0, 95%CI: 2.1, 7.8). Black and Hispanic women were more likely to prefer to see both for comorbidity care (Black OR: 3.2, 95%CI: 1.6, 6.3; Hispanic OR: 2.6, 95%CI: 1.1, 6.3). Less than a high school education was also associated with a preference for seeing both clinicians for comorbidity care. Conclusions: While patients report clear preferences for which clinicians handle various aspects of their collaborative survivorship care, variation exists by race and education. Targeting these patients to clarify clinician roles may be particularly effective in interventions to improve collaborative cancer care.

Patient preferences for provider roles in collaborative breast cancer survivorship care.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 99-99
Author(s):  
Lauren P. Wallner ◽  
Yun Li ◽  
Christopher Ryan Friese ◽  
Kevin C. Ward ◽  
Ann S. Hamilton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
Los Angeles ◽  
Preventive Care ◽  
Patient Preferences ◽  
Cancer Care ◽  
Multinomial Logistic Regression ◽  
Survivorship Care ◽  
Race And Education

99 Background: Prior studies have explored barriers to collaborative cancer care and suggest a need for greater clarity about clinician roles. However, little is known about patient’s preferences and expectations for which clinicians handle various aspects of care after primary cancer treatment. Methods: A weighted random sample of patients newly diagnosed with breast cancer in 2014-15 as reported to the Georgia and Los Angeles SEER registries were surveyed approximately 6 months after diagnosis (N = 2,342, 70% response rate). Patient preferences for which clinician handles the following aspects of care after treatment were ascertained: follow-up mammograms, screening for other cancers, general preventive care, treatment of comorbidities and reassurance about their breast cancer. Response categories included primary care clinician (PCP), cancer doctors, either or both. The associations between patient demographic and clinical factors with preferences for clinician roles were assessed using multinomial logistic regression. Results: The majority of women preferred to see oncologists for mammograms (65%), other cancer screening (64%), and reassurance about their cancer (69%), and PCPs for general preventive care (76%) and comorbidity care (79%). Black women and Hispanic women (vs. White) were more likely to prefer to see both clinicians (vs. PCP) for mammograms (Black OR: 2.8, 95%CI: 1.5, 5.1; Hispanic OR: 1.9, 95%CI: 1.1, 3.3), screening for other cancers (Black OR: 3.3, 95%CI: 1.8, 6.1; Hispanic OR: 1.8, 95%CI: 1.0, 3.1), general preventive care (Black OR: 3.5, 95%CI: 2.0, 6.0; Latina OR: 2.5, 95%CI: 1.4, 4.3) and comorbidity care (Black OR: 2.1, 95%CI: 1.3, 3.6; Hispanic OR: 2.0, 95%CI: 1.2, 3.3). Less than a high school education was also associated with a preference for seeing both clinicians for mammograms. Conclusions: While patients report clear preferences for which clinicians handle various aspects of their collaborative survivorship care, variation exists by race and education. Targeting these patients to clarify clinician roles may be particularly effective in interventions to improve collaborative cancer care.

Worry about recurrence and patient preferences for provider roles in collaborative breast cancer care.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 158-158
Author(s):  
Lauren P. Wallner ◽  
Nancy K. Janz ◽  
Yun Li ◽  
Christopher Ryan Friese ◽  
Kevin C. Ward ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Los Angeles ◽  
Preventive Care ◽  
Patient Preferences ◽  
Cancer Care ◽  
Multinomial Logistic Regression ◽  
Cancer Recurrence ◽  
Continuing Care ◽  
Patient Reported ◽  
Worry About Recurrence

158 Background: Prior studies have shown that worry about recurrence is a common problem during cancer treatment and survivorship and may be associated with symptom response and surveillance after primary treatment. However, whether worry about recurrence influences patient preferences for which provider to see for their continuing care remains unknown. Methods: A random sample of patients newly diagnosed with breast cancer in 2014-15 as reported to the Georgia and Los Angeles SEER registries were surveyed approximately 6 months after diagnosis (N = 2,502, 70% response rate). Frequency of worry about recurrence was defined by asking women to indicate on a 5-pt scale how often they worried about their cancer coming back in the past month (not at all-always) and was then dichotomized as frequent worry (sometimes/often/almost always) vs. less worry (almost never/rarely). Patient preferences for which provider manages certain aspects of care after treatment were ascertained for: follow-up mammograms, screening for other cancers, general preventive care, and treatment of comorbidities. Response categories included primary care clinician (PCP), cancer doctors, either or both. The associations between patient-reported worry about recurrence with preferences for provider roles were assessed using multinomial logistic regression. Results: In this sample, 37% of women reported worrying frequently about recurrence. Controlling for patient and clinical factors, women who reported more frequent worry (vs. less worry) were more likely to prefer to see both clinicians (vs. PCP only) for mammograms (OR: 2.3, 95%CI: 1.5, 3.6), screening for other cancers (OR: 2.3, 95%CI: 1.5, 3.5), general preventive care (OR: 1.6, 95%CI: 1.1, 2.3) and comorbidity care (OR: 1.5, 95%CI: 1.03, 2.2). Conclusions: Frequent worry about recurrence was common in this sample of women with favorable prognosis breast cancer. More frequent worry about breast cancer recurrence was associated with stronger preferences for seeing both PCPs and oncologists for continuing care after treatment. Assessing and managing worry about recurrence early in survivorship may improve collaborative cancer care and reduce duplicated services after treatment.

scholarly journals Patient Preferences for Primary Care Provider Roles in Breast Cancer Survivorship Care

2017 ◽  
Vol 35 (25) ◽  
pp. 2942-2948 ◽  
Author(s):  
Lauren P. Wallner ◽  
Yun Li ◽  
Allison K.C. Furgal ◽  
Christopher R. Friese ◽  
Ann S. Hamilton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High School ◽  
Primary Care ◽  
Preventive Care ◽  
Care Provider ◽  
Patient Preferences ◽  
Minority Women ◽  
High School Education ◽  
Survivorship Care ◽  
Care Needs

Purpose Prior studies have suggested a need for greater clarity about provider roles in team-based cancer care; however, little is known about patients’ preferences regarding which providers handle their care needs after primary cancer treatment. Methods We surveyed women with newly diagnosed stages 0 to II breast cancer who were treated in 2014 and 2015 as reported to the Georgia and Los Angeles SEER registries (N = 2,372; 68% response rate). Patient preferences regarding which provider handles the following care needs after treatment were ascertained: follow-up mammograms, screening for other cancers, general preventive care, and comorbidity management. Associations between patient demographic factors with preferences for provider roles—oncology-directed care versus primary care provider (PCP)–directed care—were assessed by using multivariable logistic regression. Results The majority of women preferred that their PCPs handle general preventive care (79%) and comorbidity care (84%), but a notable minority of women preferred that their oncologists direct this care (21% and 16%, respectively). Minority women—black and Asian versus white—and women with a high school education or less—versus undergraduate college education or more—displayed greater odds of preferring oncology-directed care—versus PCP-directed care—for their general preventive care (black odds ratio [OR], 2.01; 95% CI, 1.43 to 2.82; Asian OR, 1.74; 95% CI, 1.13 to 2.69; high school education or less OR, 1.51; 95% CI, 1.10 to 2.08). Similar variations existed for comorbidity care. Conclusion In this sample, minority women and those with less education more often preferred that oncologists direct certain aspects of their care after breast cancer treatment that are normally delivered by a PCP. Efforts to clarify provider roles in survivorship care to patients may be effective in improving team-based cancer care.

Primary care provider engagement about breast cancer care during treatment: Results from the iCanCare Study.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 101-101
Author(s):  
Lauren P. Wallner ◽  
Paul Abrahamse ◽  
Christopher Ryan Friese ◽  
Steven J. Katz ◽  
Sarah T. Hawley
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Los Angeles ◽  
Collaborative Care ◽  
Cancer Care ◽  
Primary Care Providers ◽  
Current Response ◽  
Care Providers ◽  
Breast Cancer Patients ◽  
High Quality

101 Background: Collaborative care between cancer specialists and primary care providers (PCP) ensures high quality cancer care. Yet, little is known about patient’s perspectives about the level of PCP engagement in and communication about breast cancer (BC) care during treatment. Methods: A weighted random sample of newly diagnosed breast cancer patients in the Georgia and Los Angeles SEER registries were surveyed approximately 6 months after diagnosis (expected final N = 2600, 70% current response rate). PCP BC engagement and communication were defined using 2 outcome measures (categorized as less (never/rarely) vs. more (sometimes/often/always)): how informed the respondent’s PCP was about BC treatment and how often respondents talked with their PCP about their BC care visits. Overall PCP quality was assessed by averaging patient responses (5 categories, never to always) to 5 questions: ease of access to PCP (3 questions) and PCP’s awareness of patient values (2 questions) and categorized as high ( ≥ 4), moderate (3) and low ( < 3). The associations between patient factors and PCP quality with BC engagement and communication were evaluated using multivariable logistic regression. Results: In a preliminary sample (N = 2054), the majority of women reported high PCP quality (63%), high PCP BC engagement (65%) and communication (68%). (Table) Women who reported less PCP BC engagement were more likely to report low PCP quality (OR: 15.7, 95%CI: 9.5, 25.9;) and chemotherapy use (OR: 1.3, 95%CI: 1.1, 1.6), adjusting for age, race, insurance, comorbidities and PCP continuity. The results were similar for PCP communication. Conclusions: Patient perceptions of PCP quality, engagement and communication during BC treatment are high for most women with BC. However, there remains opportunity for improvement in both, as many women report poor engagement and communication despite perceiving high quality primary care. Targeting these patients and their clinicians may be particularly effective in interventions to improve collaborative care in cancer. [Table: see text]

Integrating cancer care: Patient and practice management processes among surgeons who treat breast cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6526-6526
Author(s):  
S. J. Katz ◽  
S. T. Hawley ◽  
J. J. Griggs ◽  
M. Morrow ◽  
T. P. Hofer
Keyword(s):  
Breast Cancer ◽  
Los Angeles ◽  
Cancer Care ◽  
Practice Management ◽  
Management Process ◽  
Institute Of Medicine ◽  
Process Measures ◽  
Patient Support Group ◽  
Cancer Program ◽  
Management Processes

6526 Background: The Institute of Medicine has called for cancer care models that parallel those underway to integrate the management of patients with chronic conditions. The objective of this study was to evaluate patterns and correlates of such initiatives in the practices of surgeons treating women with breast cancer. Methods: We developed 5 multi-item scales to describe breast cancer patient and practice management processes based on the Chronic Care Model (multidisciplinary clinician communication; availability of clinical information; patient decision support; access to information technology; and practice management initiatives). We then performed a survey among attending surgeons of a population-based sample of patients diagnosed with breast cancer during a period from June 2005-February 2007 in metropolitan Los Angeles and Detroit (N = 312, response rate 76.1%). We evaluated the distribution of management process measures across selected characteristics of providers and practices. Results: About half of the surgeons devoted 15% or less of their total practice to breast cancer; while 16.2% of surgeons devoted 50% or more. The deployment of management processes varied markedly with most surgeons reporting low use. For example, only about 10% of surgeons indicated that half or more of their patients were exposed to multidisciplinary physician communication; while only 5% indicated that half or more of their patients were provided decision and care support services such as attending a presentation or viewing a video about breast cancer prior to surgery or attended a patient support group. Management process measures were positively associated with greater levels of surgeon specialization and the presence of a teaching program. Cancer program status (NCI center, ACS cancer program, neither) was weakly associated with any of the management process measures. Conclusions: The low uptake of patient and practice management processes observed in this study suggests that breast surgeons are not convinced that these processes matter or that there are logistical and cost barriers to implementation. More research is needed to understand how variation in patient and practice management processes may affect the quality of care for patients with breast cancer. No significant financial relationships to disclose.

Benchmark Method for Cost Computations Across Health Care Systems: Cost of Care per Patient per Day in Breast Cancer Care

2021 ◽  
pp. OP.20.00462
Author(s):  
Douglas W. Blayney ◽  
Tina Seto ◽  
Nhat Hoang ◽  
Craig Lindquist ◽  
Allison W. Kurian
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Initial Treatment ◽  
Cost Of Care ◽  
Third Party ◽  
Survivorship Care ◽  
Her2 Positive ◽  
Curative Intent ◽  
Social Security Death Index ◽  
Episodes Of Care

PURPOSE: To estimate the value of cancer care and to compare value among episodes of care, a transparent, reproducible, and standardized cost computation methodology is needed. Charges, claims, and reimbursements are related to cost but are nontransparent and proprietary. We developed a method to measure the cost of the following phases of care: (1) initial treatment with curative intent, (2) surveillance and survivorship care, and (3) relapse and end-of-life care. METHODS: We combined clinical data from our electronic health record, the state cancer registry, and the Social Security Death Index. We analyzed the care of patients with breast cancer and mapped Common Procedural Terminology (CPT) codes to the corresponding cost conversion factor and date in the CMS Medicare fee schedule. To account for varying duration of episodes of care, we computed a cost of care per day (CCPD) for each patient. RESULTS: Median CCPD for initial treatment was $29.45 in US dollars (USD), the CCPD for surveillance and survivorship care was $2.45 USD, and the CCPD for relapse care was $13.80 USD. Among the three breast cancer types (hormone receptor-positive or human epidermal growth factor receptor 2 [HER2]-negative, HER2-positive, and triple-negative), there was no difference in CCPD. Relapsed patients in the most expensive surveillance CCPD group had significantly shorter survival. CONCLUSION: We developed a method to identify high-value oncology care—cost of care per patient per day (CCPD)—in episodes of initial, survivorship, and relapse care. The methodology can help identify positive deviants (who have developed best practices) delivering high-value care. Merging our data with claims data from third-party payers can increase the accuracy and validity of the CCPD.

Quality care and patient involvement in their care: Preferences for transitioning cancer follow-up care to the community.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 75-75
Author(s):  
Lindsay Herzog ◽  
Doris Howell ◽  
Shari Moura ◽  
Xin Qiu ◽  
Catherine Brown ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Patient Preferences ◽  
Cancer Care ◽  
Family Doctor ◽  
Transition Of Care ◽  
Survivorship Care ◽  
Specialist Care ◽  
Cross Sectional ◽  
Direct Referral

75 Background: The cancer survivor rate is rising and a new focus has turned to the appropriate survivorship care for this new population. Although several models of survivorship care are currently present in Canada, few studies have examined cancer patient preferences. This study compared patient preferences for direct referral back to one’s primary care practitioner (PCP) after 2-3 years of oncology specialist care versustransition through a specialized transitional clinic before exclusive follow-up by one’s PCP. The main objectives were to: (1) assess patient interest in a specialized cancer transitional clinic model, and (2) compare patient and demographic characteristics by such preferences. Methods: A cross-sectional scenario-based survey of cancer survivors who had undergone curative therapy at the Princess Margaret Cancer Centre assessed patient preferences for the transitioning of their post-treatment cancer care. Regression models compared clinico-demographic and psychosocial variables (anxiety, depression, distress) to one’s preference for transition of care. Results: Among 242 cancer survivors, 54% were male, 78% Caucasian, 43% with a college degree, median household income between 60-75K, 71% married, with a wide distribution of curable cancer sites (anal, colorectal, breast, testicular, lymphoma, head/neck, lung). 77% preferred transition through a specialized transitional clinic versus direct referral back to their family doctor. No factors were found to be related to preference for transition of care, except individuals who scored high on anxiety using the ESAS scale were significantly more likely to prefer referral to the specialized transitional clinic (p<0.05). No differences in preference were found by other clinico-demographic factors. Conclusions: A specialized transitional clinic is a preferred survivorship option in three-quarters of cancer patients. Anxiety, but not other variables, was associated with preference for the specialized clinic. This study highlights the need for individual decision-making regarding survivorship options. This individualization of transitioning may help improve patient’s perception of quality cancer care.

Recent time trends in chemotherapy use and oncologists' chemotherapy recommendations for early-stage, hormone receptor-positive breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 541-541
Author(s):  
Allison W. Kurian ◽  
Irina Bondarenko ◽  
Reshma Jagsi ◽  
Chandler McLeod ◽  
Sarah T. Hawley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Los Angeles ◽  
Patient Preferences ◽  
Early Stage ◽  
Population Based ◽  
Genomic Profiling ◽  
Patient Report ◽  
Node Negative ◽  
Breast Cancer Chemotherapy ◽  
Node Positive

541 Background: Advances in tumor genomic profiling enable increasingly precise estimates of the benefit of adjuvant chemotherapy in early-stage breast cancer. However, little is known about how chemotherapy use, medical oncologists’ (MO) perspectives and recommendations have changed in recent years, particularly in key clinical subgroups such as node-negative and node-positive. Methods: We surveyed 5,080 women (70% response rate), newly diagnosed with breast cancer in 2013-2015 and accrued through two population-based SEER registries (Georgia and Los Angeles), about their MOs’ chemotherapy recommendations and whether they received chemotherapy. Using patient report, we identified 470 attending MOs and surveyed them (n=310, 66% response) about approaches to chemotherapy recommendation, using node-negative and node-positive case scenarios. We evaluated factors associated with chemotherapy receipt over time using multi-level logistic regression. Results: The analytic sample was 2,926 patients with stages I-II, estrogen receptor-positive, HER2-negative breast cancer. Chemotherapy use declined to 21% from 34% during the study period (2013-2015, p<.001). For node-positive patients, chemotherapy use declined to 64% from 81% and for node-negative/micrometastasis patients to 14% from 27%. Based on patient report, MOs’ recommendations for chemotherapy declined during the study period to 32% from 45% (p<.001). Recommendations reported by MOs were generally guideline-concordant. MOs were much more likely to order tumor genomic profiling when patient preferences were discordant with recommendations [67%, standard error (SE) 3% versus 18% (SE 2%) without discordance], and they adjusted chemotherapy recommendations based on patient preferences and genomic profiling results. Conclusions: For both node-negative/micrometastasis and node-positive patients, chemotherapy receipt and oncologists’ recommendations for chemotherapy declined markedly in recent years. The results of ongoing clinical trials of genomic profiling will be essential to confirm the quality of this approach to breast cancer care. Funded by NCI P01CA163233.

scholarly journals The Structural Landscape of the Health Care System for Breast Cancer Care: Results from The Los Angeles Women’s Health Study

2009 ◽  
Vol 15 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Diana M. Tisnado ◽  
Jennifer L. Malin ◽  
May L. Tao ◽  
Patricia Ganz ◽  
Danielle Rose-Ash ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Los Angeles ◽  
Women’S Health ◽  
Women's Health ◽  
Health Care System ◽  
Cancer Care ◽  
Health Study ◽  
Breast Cancer Care ◽  
Care System

Preliminary results from a comparative effectiveness study of breast cancer survivorship care: A University of California (UC) ATHENA Breast Health Network project.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 212-212
Author(s):  
E. E. Hahn ◽  
P. A. Ganz ◽  
M. E. Melisko ◽  
J. P. Pierce ◽  
M. M. Von Friederichs-Fitzwater ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Care Coordination ◽  
Cancer Care ◽  
Post Treatment ◽  
Breast Health ◽  
Survivorship Care ◽  
Breast Cancer Care ◽  
Preliminary Results ◽  
Key Informant

212 Background: The ATHENA Breast Health Network collaboration is a large scale, UC system-wide project initiated with the intent to drive innovation in breast cancer prevention, screening and treatment. An IRB approved research protocol was developed to examine survivorship care across Network sites, which includes key informant interviews at each site and patient/survivor surveys. This abstract presents preliminary analyses from the key informant interviews. Methods: Investigators at each site conducted semi-structured interviews with oncology specialists and primary care providers (PCPs). Interviews used case study examples and open and closed-ended questions on the delivery of post-treatment breast cancer care. Informant responses were manually recorded by the interviewer, compiled in a database, then coded and analyzed using NVIVO9 software. Results: There were 39 key informants across five participating UC sites: 14 medical oncologists, 7 radiation oncologists, 11 surgeons, 3 oncology nurses, and 4 PCPs. Care coordination is a major unprompted theme identified in the interviews. 85% of all participants reported using shared care coordination between PCP and oncology for post-treatment follow-up. 49% report the need for greater care coordination in general, and 28% report the need for greater care coordination within oncology, particularly to help avoid duplication of follow-up care and services. The responses demonstrate wide variability among provider types and institutions (Table). Additional analyses from this study will be updated in our presentation. Conclusions: These preliminary results identify the need for focus on care coordination during the post-treatment phase of breast cancer care within the UC system. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document