title: Generalists and oncologists show similar care practices and outcomes for hospitalized late-stage cancer patients. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks for Treatment.
abstract: OBJECTIVE
  The objective of this work was to identify similarities and differences in primary attending physicians' (generalists' versus oncologists') care practices and outcomes for seriously ill hospitalized patients with malignancy.
  
  
  METHODS
  This was a prospective cohort study (SUPPORT project).
  
  
  METHODS
  Subjects were recruited from 5 US teaching hospitals; data were gathered from 1989 to 1994.
  
  
  METHODS
  Included in the study was a matched sample of 642 hospitalized patients receiving care for non-small-cell lung cancer, colon cancer metastasized to the liver, or multiorgan system failure associated with malignancy with either a generalist or an oncologist as the primary attending physician.
  
  
  METHODS
  Care practices and patient outcomes were determined from hospital records. Length of survival was identified with the National Death Index. Physicians' perceptions of patient's prognosis, preference for cardiopulmonary resuscitation (CPR), and length of relationship were assessed by interview. A propensity score for receiving care from an oncologist was constructed. After propensity-based matching of patients, practices and outcomes of oncologists' and generalists' patients were assessed through group comparison techniques.
  
  
  RESULTS
  Generalist and oncologist attendings showed comparable care practices, including the number of therapeutic interventions, eg, "rescue care" and chemotherapy, and the number of care topics discussed with patients/ families. Length of stay, discharge to supportive care, readmission, total hospital costs, and survival rates were similar. For both physician groups, perception of patients' wish for CPR was associated with rescue care (P < 0.03), and such care was related to higher hospital costs (P < 0.000). Poorer prognostic estimates predicted aggressiveness-of-care discussions by both types of physicians. Length of the patient-doctor relationship was associated with oncologists' care practices. More documented discussion about aggressiveness of care was related to higher hospital costs and shorter survival for patients in both physician groups (P < 0.001).
  
  
  CONCLUSIONS
  Generalists and oncologists showed similar care practices and outcomes for comparable hospitalized late-stage cancer patients. Physicians' perceptions about patients' preferences for CPR and prognosis influenced decision making and outcomes for patients in both physician groups. Length of relationship with patients was associated only with oncologists' care practices. Rescue care increased hospital costs but had no effect on patient survival. Future studies should compare physicians' palliative care as well as acute-care practices in both inpatient and ambulatory care settings. Patients' end-of-life quality and interchange between physician groups should also be documented and compared.
authors.affiliation: Department of Medicine-Geriatrics, Case Western Reserve University School of Medicine, Celeveland, Ohio 44120, USA. jhr8@po.cwru.edu
authors.forename: J H
authors.initials: JH
authors.lastname: Rose
authors.forename: E E
authors.initials: EE
authors.lastname: O'Toole
authors.forename: N V
authors.initials: NV
authors.lastname: Dawson
authors.forename: C
authors.initials: C
authors.lastname: Thomas
authors.forename: A F
authors.initials: AF
authors.lastname: Connors
authors.forename: N
authors.initials: N
authors.lastname: Wenger
authors.forename: R S
authors.initials: RS
authors.lastname: Phillips
authors.forename: M B
authors.initials: MB
authors.lastname: Hamel
authors.forename: D T
authors.initials: DT
authors.lastname: Reding
authors.forename: H J
authors.initials: HJ
authors.lastname: Cohen
authors.forename: J
authors.initials: J
authors.lastname: Lynn
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data*; D008505:Medical Staff, Hospital / Q000523:psychology; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D016414:Resuscitation Orders; D016019:Survival Analysis; D013727:Terminal Care / Q000706:statistics & numerical data*