The assessment of values in laryngeal cancer: reliability of measurement methods
Female; Humans; Male; Adult; Attitude to Health; Aged; Middle Aged; Social Values; Time Factors; Non-U.S. Gov't; Research Support; Psychological; Evaluation Studies; Interview; Laryngeal Neoplasms/psychology/radiotherapy; Voice; Voice Quality
Although quantitative estimates of patients' attitudes toward the relative importance of different aspects of health are of great potential usefulness in medical decision making, there is little information about the stability of such values over time, particularly in patients whose clinical state is changing. To examine these questions, we selected a group of patients with laryngeal cancer undergoing treatment with radiotherapy. In this group of patients clinical problems are relatively circumscribed and related to the voice, and a temporary deterioration in voice-related symptoms and abilities is expected during treatment. Thirty patients were interviewed at the start and completion of a month's course of treatment. At each interview patients rated the quality of their own voices using a number of visual analogue scales and also provided both holistic and decomposed quantitative values for the importance of different aspects of voice function and sound. Although the analogue scales demonstrated the anticipated deterioration in the quality of the patients' voices, these changes in clinical state were not accompanied by any changes in the values the patients assigned to each aspect of voice sound and function. These results indicate that at least in the short term the values expressed by patients appear to be stable and uninfluenced by changes in their own clinical state. Longer term studies involving more systemic illnesses should now be carried out.
1984
Llewellyn-Thomas HA; Sutherland HJ; Ciampi A; Etezadi-Amoli J; Boyd NF; Till JE
Journal Of Chronic Diseases
1984
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/0021-9681(84)90136-x" target="_blank" rel="noreferrer">10.1016/0021-9681(84)90136-x</a>
An overview of National Hospice Study findings
United States; Palliative Care; Home Nursing; quality of life; Non-U.S. Gov't; U.S. Gov't; Comparative Study; Costs and Cost Analysis; Psychological; Stress; Human; Support; Non-P.H.S.; Public Policy; Hospices/economics; Terminal Care/economics
1986
Greer DS; Mor V
Journal Of Chronic Diseases
1986
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
An alternative in terminal care: results of the National Hospice Study
Female; Hospitalization; Male; United States; Adult; Aged; Health Services Research; Cancer Care Facilities; Outcome and Process Assessment (Health Care); quality of life; Non-U.S. Gov't; U.S. Gov't; Comparative Study; Models; Costs and Cost Analysis; Health; Insurance; Medicare/economics; Human; Theoretical; Support; Middle Age; home care services; Non-P.H.S.; Neoplasms/physiopathology/psychology/therapy; Hospices/classification/economics/organization & administration; Terminal Care/economics/organization & administration; Pain/epidemiology; Reimbursement/economics
Hospice is a program of supportive services for terminally ill patients and their families, provided either at home or in designated inpatient settings, which is purported to improve patient and family quality of life at lower cost than conventional terminal care. The National Hospice Study was a multi-site, quasi-experimental study to compare the experiences of terminal cancer patients and their families in hospices with those of similar patients and families receiving conventional terminal care. The results indicate that, although care is different in hospices, e.g. lesser utilization of aggressive interventional therapy and diagnostic testing, patients' quality of life is similar in the hospice and conventional care systems with the exception of pain and symptom control, which may be better in the inpatient hospice setting. Hospice patients are more likely to die at home and their families are satisfied with that outcome. Otherwise, no consistent superiority of family outcome was associated with the hospice approach. The cost of hospice care is less than that of conventional terminal care for patients in hospices without inpatient facilities, but the cost of hospice appears to be equivalent to conventional care for patients in hospices having beds.
1986
Greer DS; Mor V; Morris JN; Sherwood S; Kidder D; Birnbaum H
Journal Of Chronic Diseases
1986
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
National hospice study analysis plan
United States; Family; Research Design; Non-U.S. Gov't; P.H.S.; U.S. Gov't; Models; Costs and Cost Analysis; Human; Theoretical; Support; Hospices/economics; Evaluation Studies/methods; Health Services Research/methods
Since the founding of the first hospice in the United States in 1974, the number of health care organizations providing hospice services has grown rapidly. In 1978, the U.S. General Accounting Office identified 59 operational hospices [1]. A survey undertaken by the National Hospice Organization (NHO) in 1980 found 235 operational programs and many more actively planning to deliver services. By the summer of 1981, the Joint Commission on the Accreditation of Hospitals (JCAH), in studying the feasibility of a voluntary hospice accreditation program, had 650 responses to a national survey [2]. Finally, the 1981 NHO directory identifies 464 operational "provider programs" as well as 33 functioning state-level hospice organizations with an additional 353 programs in various stages of establishing hospice programs of care [3]. The growth of the movement and the public recognition it has received have catalyzed advocacy of Federal support for hospice services. In 1979, the Congress responded by mandating a study to delineate the implications of inclusion of hospice services in the Medicare program. The Health Care Financing Administration (HCFA) then selected 26 hospices (from an applicant pool of 233) to participate in a two-year experimental program. These demonstration sites receive reimbursement for services provided Medicare beneficiaries not otherwise available under current regulations. The special reimbursement provisions went into effect on October 1, 1980. (See Appendix A: Description of the Hospice Reimbursement Program.) In the spring of 1980, the Robert Wood Johnson Foundation and the John A. Hartford Foundation joined with the Health Care Financing Administration (HCFA) to solicit proposals for a national evaluation of hospice care as a basis for future Federal fiscal policy and legislation. Brown University was selected as the evaluation center by competitive process and the grant was awarded on September 30, 1980. The evaluation employs a quasi-experimental design in which the impact of hospice care (with and without reimbursement) on quality of life and costs are compared to non-hospice (conventional) terminal care. Eight hundred patients and families in 24 comparison sites located in three regional areas (Southern New England, Northern Midwest and Southern California) are expected to participate. Primary data collection began on August 1, 1981. Analyses of differential outcome are performed using standard linear multiple regression and logistic multiple regression with separate models for each comparison group. Effects are tested by separately estimating the specific response variable for the prototype (average) hospice patient for each model.
1983
Greer DS; Mor V; Sherwood S; Morris JN; Birnbaum H
Journal Of Chronic Diseases
1983
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article