Generalists and Oncologists Show Similar Care Practices and Outcomes for Hospitalized Late-Stage Cancer Patients

Objective. The objective of this work was to identify similarities and differences in primary attending physicians' (generalists' versus oncologists') care practices and outcomes for seriously ill hospitalized patients with malignancy. Design. This was a prospective cohort study (SUPP...

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Bibliographic Details
Published in:Medical care 2000-11, Vol.38 (11), p.1103-1118
Main Authors: Rose, Julia Hannum, O'Toole, Elizabeth E., Dawson, Neal V., Thomas, Charles, Connors, Alfred F., Wenger, Neil, Phillips, Russell S., Hamel, Mary Beth, Reding, Douglas T., Cohen, Harvey J., Lynn, Joanne
Format: Article
Language:English
Subjects:
Chemotherapy
Health outcomes
Hospital costs
Hospitalization
Internships
Medical practice
Medical treatment
Oncology
Physicians
Resource utilization
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Summary:Objective. The objective of this work was to identify similarities and differences in primary attending physicians' (generalists' versus oncologists') care practices and outcomes for seriously ill hospitalized patients with malignancy. Design. This was a prospective cohort study (SUPPORT project). Setting. Subjects were recruited from 5 US teaching hospitals; data were gathered from 1989 to 1994. Subjects. Included in the study was a matched sample of 642 hospitalized patients receiving care for non-small-cell lung cancer, colon cancer metastasized to the liver, or multiorgan system failure associated with malignancy with either a generalist or an oncologist as the primary attending physician. Measurements. Care practices and patient outcomes were determined from hospital records. Length of survival was identified with the National Death Index. Physicians' perceptions of patient's prognosis, preference for cardiopulmonary resuscitation (CPR), and length of relationship were assessed by interview. A propensity score for receiving care from an oncologist was constructed. After propensity-based matching of patients, practices and outcomes of oncologists' and generalists' patients were assessed through group comparison techniques. Results. Generalist and oncologist attendings showed comparable care practices, including the number of therapeutic interventions, eg, "rescue care" and chemotherapy, and the number of care topics discussed with patients/families. Length of stay, discharge to supportive care, readmission, total hospital costs, and survival rates were similar. For both physician groups, perception of patients' wish for CPR was associated with rescue care (P
ISSN:0025-7079
1537-1948
DOI:10.1097/00005650-200011000-00005