Effect of physician perspective on allocation of Medicare resources for patients with advanced cancer.
OBJECTIVE
To assess how physician perspective (perspective of patient vs perspective of physician) affects Medicare resource allocation for patients with advanced cancer and compare physician allocations with actual cancer patient and caregiver allocations.


METHODS
Cross-sectional assessment.


METHODS
National assessment.


METHODS
Otolaryngologists.


METHODS
Physicians used a validated tool to create a Medicare plan for patients with advanced cancer. Participants took the perspective of an advanced cancer patient and made resource allocations between 15 benefit categories (assessment 2, November/December 2012). Results were compared with data from a prior assessment made from a physician's perspective (assessment 1, February/March 2012) and with data from a separate study with patients with cancer and caregivers.


RESULTS
In total, 767 physicians completed assessment 1 and 237 completed assessment 2. Results were compared with 146 cancer patient and 114 caregiver assessments. Assessment 1 physician responses differed significantly from patients/caregivers in 14 categories (P < .05), while assessment 2 differed in 11. When comparing physician data, assessment 2 allocations differed significantly from assessment 1 in 7 categories. When these 7 categories were compared with patient/caregiver data, assessment 2 allocations in emotional care, drug coverage, and nursing facility categories were not significantly different. Assessment 1 allocations in cosmetic care, dental, home care, and primary care categories were more similar to patient/caregiver preferences, although all but home care were still significantly different.


CONCLUSIONS
Otolaryngology-head and neck surgery 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. This demonstrates the challenges inherent in end-of-life discussions.
Department of Surgery, Division of Otolaryngology, Head & Neck Surgery (OHNS), Duke University Medical Center, Durham, North Carolina, USA.
Daniel J
DJ
Rocke
Halton W
HW
Beumer
Steven
S
Thomas
Walter T
WT
Lee
D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010036:Otolaryngology; D010820:Physicians / Q000523:psychology*; D040841:Resource Allocation; D014481:United States
Medicare; cancer; decision making; end of life; quality of life