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Original Investigation |

Physician and Patient and Caregiver Health Attitudes and Their Effect on Medicare Resource Allocation for Patients With Advanced Cancer

Daniel J. Rocke, MD, JD1; Halton W. Beumer, MD1,2; Donald H. Taylor Jr, MPA, PhD3,4; Steven Thomas, MS5; Liana Puscas, MD1; Walter T. Lee, MD1,6
[+] Author Affiliations
1Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
2now with Medical Corps, US Air Force, Joint Base Langley-Eustis, Virginia
3Duke Sanford School of Public Policy, Durham, North Carolina
4Community and Family Medicine and Nursing, Duke University Medical Center, Durham, North Carolina
5Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
6Section of Otolaryngology, Durham VA Medical Center, Durham, North Carolina
JAMA Otolaryngol Head Neck Surg. 2014;140(6):497-503. doi:10.1001/jamaoto.2014.494.
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Importance  Physicians must participate in end-of-life discussions, but they understand poorly their patients’ end-of-life values and preferences. A better understanding of these preferences and the effect of baseline attitudes will improve end-of-life discussions.

Objective  To determine how baseline attitudes toward quality vs quantity of life affect end-of-life resource allocation.

Design, Setting, and Participants  Otolaryngology–head and neck surgery (OHNS) physicians were recruited to use a validated online tool to create a Medicare health plan for advanced cancer patients. During the exercise, participants allocated a limited pool of resources among 15 benefit categories. These data were compared with preliminary data from patients with cancer and their caregivers obtained from a separate study using the same tool. Attitudes toward quality vs quantity of life were assessed for both physicians and patients and caregivers.

Interventions  Participation in online assessment exercise.

Main Outcomes and Measures  Medicare resource allocation.

Results  Of 9120 OHNS physicians e-mailed, 767 participated. Data collected from this group were compared with data collected from 146 patients and 114 caregivers. Compared with patients and caregivers, OHNS physician allocations differed significantly in all 15 benefit categories except home care. When stratified by answers to 3 questions about baseline attitudes toward quality vs quantity of life, there were 3 categories in which allocations of patients and caregivers differed significantly from the group with the opposite attitude for at least 2 questions: other medical care (question 1, P < .001; question 2, P = .005), palliative care (question 1, P = .008; question 2, P = .006; question 3, P = .009), and treatment for cancer (questions 1 and 2, P < .001). In contrast, physician preferences showed significant differences in only 1, nonmatching category for each attitude question: cash (question 1, P = .02), drugs (question 2, P = .03), and home care (question 3, P = .048).

Conclusions and Relevance  Patients with cancer and their caregivers have different preferences from physicians. These preferences are, for these patients and their caregivers, affected by their baseline health attitudes, but physician preferences are not. Understanding the effect of baseline attitudes is important for effective end-of-life discussions.

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Figure.
Screenshot of the Online Version of the Choosing Healthplans All Together (CHAT) Tool

Screenshot shows the categories and number of resource units needed for coverage at each level. Reprinted with permission from Rocke et al.11

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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