Effect of Physician Perspective on Allocation of Medicare Resources for Patients with Advanced Cancer. (23rd August 2013)

• Record Type: Journal Article
• Authors: Rocke, Daniel J.; Beumer, Halton W.; Taylor, Donald H.; Schulz, Kristine A.; Thomas, Steven; Puscas, Liana; Lee, Walter T.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 149(2013)Supplement 2
• Page Start: P62
• Page End: P62
• Publication Date: 2013-08-23
• Subjects: Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599813495815a87
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objectives: 1) Assess how physician perspective affects Medicare resource allocation for advanced cancer patients. 2) Compare how physician allocations differ from advanced cancer patients and their caregivers. Methods: Otolaryngology–head and neck surgery (OHNS) physicians nationwide used a validated tool to create a Medicare plan for advanced cancer patients. Participants took the perspective of an advanced cancer patient and made resource allocations between 15 benefit categories (round 2, November/December 2012). Results were compared with data from a prior assessment made from a physician's perspective (round 1, February/March 2012) and with data from an ongoing study with cancer patients and caregivers. Results: Seven hundred and sixty‐seven physicians completed round 1, and 237 completed round 2. Results were compared with 146 cancer patients and 114 caregivers. Round 1 physician responses differed significantly from patients/caregivers in 13 categories ( P < 0.05), while round 2 differed significantly in 11. When comparing physician data, round 2 allocations differed significantly from round 1 in 7 categories. When these 7 categories were compared with patient/caregiver data, round 2 allocations in the Emotional Care, Drug Coverage, and Nursing Facility categories were not significantly different from patient/caregiver allocations. In 4 categories, Cosmetic Care, Dental, Home Care, and Primary Care, round 1 allocations were more similar to patient/caregiver allocations, although all but Home Care were still significantly different. Conclusions: OHNS physician perspectives on end‐of‐life care differ significantly from cancer patient/caregiver perspectives even when physicians take a patient's perspective when allocating resources. These findings demonstrate the challenges inherent in end‐of‐life discussions between physicians and patients.