The project will develop a palliative care benefit for the Medicare program that is based on the care preferences of selected patients with metastatic cancer (non small cell lung;pancreatic;biliary;and melanoma) and their families facing the end of life. Care preferences will be elicited using the Choosing Health Plans All Together (CHAT) methodology. This approach provides patients and family members with actuarially accurate cost tradeoffs of alternatives types of health care that could be chosen. All types of care cannot be afforded, so the decision is made under a scarcity constraint. The CHAT game approach begins with individual judgment of care preferences, and proceeds to two group based decision making rounds before concluding with a final individual assessment. The CHAT approach has been used successfully with Medicare beneficiaries. We will propose a new palliative care benefit using the patient and family preferences as the primary input, and will then simulate the expected cost of such a benefit were it implemented in Medicare, and compare it to the projected costs of the current Medicare hospice benefit. The goal of the project is to develop a palliative care benefit that will increase quality of life while minimizing health care costs.

Public Health Relevance

The project will develop a palliative care benefit for the Medicare program that is based on the care preferences of selected patients with metastatic cancer (non small cell lung;pancreatic;biliary;and melanoma) and their families facing the end of life. The cost of the proposed benefit will be projected and compared with the current Medicare hospice benefit. The goal of the project is to develop a palliative care benefit that will increase quality of life while minimizing health care costs.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS018360-04
Application #
8295948
Study Section
Health Systems Research (HSR)
Program Officer
Hagan, Michael
Project Start
2009-09-30
Project End
2014-07-31
Budget Start
2012-08-01
Budget End
2014-07-31
Support Year
4
Fiscal Year
2012
Total Cost
Indirect Cost
Name
Duke University
Department
Administration
Type
Schools of Arts and Sciences
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Taylor Jr, Donald H; Danis, Marion; Zafar, S Yousuf et al. (2014) There is a mismatch between the medicare benefit package and the preferences of patients with cancer and their caregivers. J Clin Oncol 32:3163-8
Rocke, Daniel J; Beumer, Halton W; Thomas, Steven et al. (2014) Effect of physician perspective on allocation of Medicare resources for patients with advanced cancer. Otolaryngol Head Neck Surg 150:792-800
Danis, Marion; Abernethy, Amy P; Zafar, S Yousuf et al. (2014) A decision exercise to engage cancer patients and families in deliberation about Medicare coverage for advanced cancer care. BMC Health Serv Res 14:315
Taylor Jr, Donald H; Bull, Janet; Zhong, Xiaoyin et al. (2013) The effect of palliative care on patient functioning. J Palliat Med 16:1227-31