Effect of Physician Perspective on Allocation of Medicare Resources for Patients with Advanced Cancer

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.