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Lebanon, New Hampshire 03766


Purpose:

This is a qualitative study of local organizational and provider practice norms, and how these norms influence patient and family expectations and provider decision-making heuristics for minority patients with advanced cancer at major US cancer centers. Outpatient visits with oncologists will be observed and documented via hand-written field notes. Semi-structured interviews with selected participating clinicians, patients, caregivers, and other informants will follow the initial observation.


Study summary:

The purpose of this study is to identify organizational and clinician practice norms at major US cancer centers, and how these norms influence patient and family expectations and provider decision-making heuristics for later-line chemotherapy, hospice, and ICU admission among minority patients with advanced cancer. Norms are rules about which there is at least some degree of consensus, enforced through social sanctions. Heuristics are unconscious judgments or rules of thumb.The study team will collect direct observation data from outpatient clinic visits, and semi-structured interview data from selected participating clinicians, patients, caregivers, and other informants following the initial observation. The study team will perform 2-week, qualitative case studies of 6 theoretically sampled National Comprehensive Cancer Network (NCCN) and NCI Comprehensive Cancer Centers. Oncology practice managers' nominations of clinicians with particular cancer focuses, high volumes, and high peer influence will be used to sample oncologic clinicians to shadow in outpatient clinic settings. Observations will be hand-written during the clinic visit, and later dictated and transcribed. Observed clinicians will be invited to be interviewed. Select patients and caregivers will also be invited to be interviewed following initial clinic observation. Other informants will be invited to be interviewed on an ad hoc basis. All interviews will be audio recorded and transcribed, and interviews will be semi-structured to allow for natural flow of conversation. Observations and interviews will all be done by the study PI, project coordinator, and/or another research team member. Clinical observations and semi-structured interviews will assess the following outcomes: 1) formal and informal organizational norms influencing clinician decision-making, 2) clinician decision-making heuristics, and 3) patient and caregiver expectations. All outcomes will be assessed regarding receipt of chemotherapy in the last 14 days of life, intensive care unit (ICU) admission in the last 30 days of life, and non or late hospice referral.


Criteria:

Clinician Inclusion Criteria: - Hospital-based clinicians (e.g., hospitalists, intensivists, emergency medicine, advanced practice providers) or oncology providers (e.g. medical oncologists, radiation oncologists, surgical oncologists, advanced practice providers) - Care for patients with advanced cancer - High clinical load - Have high peer influence Patient (and Caregiver) Inclusion Criteria: - Advanced cancer - Clinician "would not be surprised" if patient died in the next 12 months Other Informant Inclusion Criteria: - Member of the cancer center, hospital, unit, or service line leadership Patient (and Caregiver) Exclusion Criteria: - Potential medical malpractice cases - Decline invitation to interview


NCT ID:

NCT03780816


Primary Contact:

Principal Investigator
Amber E Barnato, MD
Dartmouth-Hitchcock Medical Center


Backup Contact:

N/A


Location Contact:

Lebanon, New Hampshire 03766
United States



There is no listed contact information for this specific location.

Site Status: N/A


Data Source: ClinicalTrials.gov

Date Processed: February 04, 2019

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