Despite many claims suggesting otherwise, inappropriate demands for diagnostics and treatment by cancer patient are few and very rarely lead to unnecessary tests and treatments from their health care providers. This is the conclusion based on new results from a study that will be presented by researchers from the Abramson Cancer Center (ACC) and the Perelman School of Medicine at the University of Pennsylvania during the 50th annual meeting of the American Society of Clinical Oncology (ASCO), which will be held in Chicago, Il, May 30 – June 3, 2014.
The Penn Medicine team, including lead author Keerthi Gogineni, MD, MSHP, an instructor in the division of Hematology-
Oncology in the ACC, surveyed 26 oncologists and nurse practitioners immediately after patient encounters at the ACC?2,050 in total?to determine frequency of patient requests or demands for tests and treatment, whether those requests were appropriate, whether they were granted and why.
Debunking misconceptions
“The results from this new study help debunk many of the misconceptions people have about patient demands leading to unnecessary tests and treatments as a major source of higher health care costs in the US,” said Gogineni. “In this study, inappropriate cancer patient demands were uncommon, and in less than 1% of the cases did providers order an inappropriate treatment or test when requested by patients.
…Rather than being driven by patients to employ low-value, high cost care, most of the time oncologists and nurse practitioners incorporated patients’ requests into a suitable plan of action…
“Clinicians felt that the majority of patient directed requests were appropriate. The data suggests that rather than being driven by patients to employ low-value, high cost care, most of the time oncologists and nurse practitioners incorporated patients’ requests into a suitable plan of action.”
Questions about patient demands were raised last year after results from a study presented by Penn Medicine researchers at the 2013 annual meeting of the American Society of Clinical Oncology revealed that over 80% of the general public, 69% of patients, and 70% of doctors surveyed believed hospitals and doctors conducted unnecessary tests and provided unnecessary treatments, and over 50% believed patients requested unnecessary tests or treatments.
Important questions
Researchers wondered if this was actually happening and if cancer patient demands could be part of the problem? The answers to these questions are important ones to explore, particularly in the oncology setting, where drugs and tests can get expensive. Hence, to find out, the team, including Ezekiel J. Emanuel, MD, PhD, chairman of the department of Medical Ethics and Health Policy, broke down the 177 encounters where patients had requests or demands regarding treatment or tests.
Survey results
The survey revealed that nearly 80% of the time the requests or demands from patients were deemed appropriate by the clinician and followed through. The rest were considered inappropriate based on the clinician’s judgment and were not ordered. Of the total number of encounters, there were only four instances (0.2%) where a clinician ordered an inappropriate test or treatment because of a patient’s demand.
The patient base was mostly non-Hispanic white (73%) with a mean age of 60. Overall, 42% had advanced stage or refractory disease, and 66 percent were undergoing active treatment?49.5% had palliative intent. Among the 26 clinicians surveyed, 97% were white, 54% were female and had a median of 14 years of post-training experience. Too few cases of inappropriate test ordering and treatments precluded the team from making any associations with demographics or disease state to the patient or provider base.
Cost-effective care
“Rightfully, there is a big push towards more cost-effective care,” said Gogineni. “Oncology in particular has been under the lens because of expensive tests and treatments that sometimes have marginal positive effects. So it’s important to show the influence of demands and requests, which appear to be very uncommon among cancer patients?and most likely do not drive overutilization of high cost or low-value medical services.”
For more information:
Keerthi Gogineni, MD, MSHP will present the team’s findings at ASCO on Tuesday, June 3, 2014 in the Health Services Research poster session from 8 a.m. to 11 a.m. in McCormick Place E354b(Abstract #6530)
