JAMA Otolaryngol Head Neck Surg. 2014 Apr 24. doi: 10.1001/jamaoto.2014.494. [Epub ahead of print]

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

Rocke DJ1, Beumer HW2, Taylor DH Jr3, Thomas S4, Puscas L1, Lee WT5.

Author information

• 1Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
• 2Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina2now with Medical Corps, US Air Force, Joint Base Langley-Eustis, Virginia.
• 3Duke Sanford School of Public Policy, Durham, North Carolina4Community and Family Medicine and Nursing, Duke University Medical Center, Durham, North Carolina.
• 4Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
• 5Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina6Section of Otolaryngology, Durham VA Medical Center, Durham, North Carolina.

Abstract

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. I

NTERVENTIONS 

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.