Evaluation of Prostate Cancer Care at the End of Life in the Managed Care Environment

Background

End-of-life care has come under much scrutiny in the last several years. It has been described as over-medicalized and has rarely been found to meet the needs of patients and their families.

Study Aims

The Evaluation of End-of-Life Care for Prostate Cancer in the Managed Care Environment will elucidate information that may lead to improved care for these patients. The aims are to:

1. identify signs and symptoms in the last stages of life;
2. describe the management of these signs and symptoms;
3. explore information on communication between patients, providers, and families;
4. evaluate data for measuring adherence to existing end-of-life guidelines and/or patient preferences;
5. measure service utilization in the last stages of life; and
6. identify factors potentially affecting care such as co-morbid conditions, socioeconomic status, and cultural or ethnic preferences.

Methods

The study is being conducted by two CRN health plans, Group Health Cooperative (GHC), and Henry Ford Health System/Health Alliance Plan (HFHS/HAP). GHC and HFHS/HAP retrospectively collected descriptive data on approximately 300 deaths due to prostate cancer. Prostate cancer deaths occurring between 1990 and 1999, were identified by matching plan enrollment data to SEER or State Cancer Registry data. Medical records were reviewed and data on end-of-life care collected. Data of interest included, information on symptoms and co-morbid illness, medical management, communication with patients and families, adherence to patient preferences, and adherence to guidelines such as those provided by the National Hospice Organization. The inclusion/exclusion of some of these variables will depend on the availability of data across participating sites. Finally, automated ambulatory care, hospitalization, and/or claims data are being used to measure utilization.

Significance

Prostate cancer in particular represents a group of patients, elderly and minority, at high risk for poor end-of-life care. Prostate cancer is the second leading cause of cancer deaths among US men, and men 70 years of age or older account for 80% of these deaths. Worldwide, African-American men have the highest measured incidence of prostate cancer.

Project Status

This study was funded through a task order contract with the Centers for Disease Control. Initiated in September 2001, the study is in the data analysis phase.

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