Variation in Cancer Centers' End-of-Life Quality
| Status: | Enrolling by invitation |
|---|---|
| Conditions: | Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/22/2019 |
| Start Date: | May 2019 |
| End Date: | June 2023 |
This is a qualitative study of local organizational and provider practice norms, and how
these norms influence patient and family expectations and provider decision-making heuristics
for minority patients with advanced cancer at major US cancer centers. Outpatient visits with
oncologists will be observed and documented via hand-written field notes. Semi-structured
interviews with selected participating clinicians, patients, caregivers, and other informants
will follow the initial observation.
these norms influence patient and family expectations and provider decision-making heuristics
for minority patients with advanced cancer at major US cancer centers. Outpatient visits with
oncologists will be observed and documented via hand-written field notes. Semi-structured
interviews with selected participating clinicians, patients, caregivers, and other informants
will follow the initial observation.
The purpose of this study is to identify organizational and clinician practice norms at major
US cancer centers, and how these norms influence patient and family expectations and provider
decision-making heuristics for later-line chemotherapy, hospice, and ICU admission among
minority patients with advanced cancer. Norms are rules about which there is at least some
degree of consensus, enforced through social sanctions. Heuristics are unconscious judgments
or rules of thumb.The study team will collect direct observation data from outpatient clinic
visits, and semi-structured interview data from selected participating clinicians, patients,
caregivers, and other informants following the initial observation.
The study team will perform 2-week, qualitative case studies of 6 theoretically sampled
National Comprehensive Cancer Network (NCCN) and NCI Comprehensive Cancer Centers. Oncology
practice managers' nominations of clinicians with particular cancer focuses, high volumes,
and high peer influence will be used to sample oncologic clinicians to shadow in outpatient
clinic settings. Observations will be hand-written during the clinic visit, and later
dictated and transcribed. Observed clinicians will be invited to be interviewed. Select
patients and caregivers will also be invited to be interviewed following initial clinic
observation. Other informants will be invited to be interviewed on an ad hoc basis. All
interviews will be audio recorded and transcribed, and interviews will be semi-structured to
allow for natural flow of conversation. Observations and interviews will all be done by the
study PI, project coordinator, and/or another research team member.
Clinical observations and semi-structured interviews will assess the following outcomes: 1)
formal and informal organizational norms influencing clinician decision-making, 2) clinician
decision-making heuristics, and 3) patient and caregiver expectations. All outcomes will be
assessed regarding receipt of chemotherapy in the last 14 days of life, intensive care unit
(ICU) admission in the last 30 days of life, and non or late hospice referral.
US cancer centers, and how these norms influence patient and family expectations and provider
decision-making heuristics for later-line chemotherapy, hospice, and ICU admission among
minority patients with advanced cancer. Norms are rules about which there is at least some
degree of consensus, enforced through social sanctions. Heuristics are unconscious judgments
or rules of thumb.The study team will collect direct observation data from outpatient clinic
visits, and semi-structured interview data from selected participating clinicians, patients,
caregivers, and other informants following the initial observation.
The study team will perform 2-week, qualitative case studies of 6 theoretically sampled
National Comprehensive Cancer Network (NCCN) and NCI Comprehensive Cancer Centers. Oncology
practice managers' nominations of clinicians with particular cancer focuses, high volumes,
and high peer influence will be used to sample oncologic clinicians to shadow in outpatient
clinic settings. Observations will be hand-written during the clinic visit, and later
dictated and transcribed. Observed clinicians will be invited to be interviewed. Select
patients and caregivers will also be invited to be interviewed following initial clinic
observation. Other informants will be invited to be interviewed on an ad hoc basis. All
interviews will be audio recorded and transcribed, and interviews will be semi-structured to
allow for natural flow of conversation. Observations and interviews will all be done by the
study PI, project coordinator, and/or another research team member.
Clinical observations and semi-structured interviews will assess the following outcomes: 1)
formal and informal organizational norms influencing clinician decision-making, 2) clinician
decision-making heuristics, and 3) patient and caregiver expectations. All outcomes will be
assessed regarding receipt of chemotherapy in the last 14 days of life, intensive care unit
(ICU) admission in the last 30 days of life, and non or late hospice referral.
Clinician Inclusion Criteria:
- Hospital-based clinicians (e.g., hospitalists, intensivists, emergency medicine,
advanced practice providers) or oncology providers (e.g. medical oncologists,
radiation oncologists, surgical oncologists, advanced practice providers)
- Care for patients with advanced cancer
- High clinical load
- Have high peer influence
Patient (and Caregiver) Inclusion Criteria:
- Advanced cancer
- Clinician "would not be surprised" if patient died in the next 12 months
Other Informant Inclusion Criteria:
- Member of the cancer center, hospital, unit, or service line leadership
Patient (and Caregiver) Exclusion Criteria:
- Potential medical malpractice cases
- Decline invitation to interview
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