Breast cancer patients suffer from the symptoms of their illness as well as from burden of treatment imposed by their care. Patients with high levels of burden tend to be less compliant with treatment plans resulting in worsening outcomes. To address the problem of overburden, some providers have proposed practicing minimally disruptive medicine, where treatment plans are tailored to the patientsâ capacity to handle the care. While some researchers have developed surveys that identify and quantify factors that contribute to treatment burden, no studies have used the electronic health record to assess patient burden. We developed measures derived from outpatient and inpatient encounter data that included time spent in appointments, waiting time, unique appointment days, and total inpatient length of stay. We used these measures to differentiate burden of treatment in early stage breast cancer patients in the first eighteen months after diagnosis. This method allowed us to identify outliers and to characterize the pattern of treatment over time. Our measures could also be used to evaluate new therapeutic and operational interventions for their effect on treatment burden. In patients receiving chemotherapy at Vanderbilt, a non-inferior change in protocol successfully reduced treatment burden while a therapeutically superior treatment may have imposed an increase of burden on patients. As the complexity of healthcare increases and patients take on more responsibility to manage their care, understanding treatment burden is critical to helping providers prescribe care right-sized for the patient to improve compliance and clinical outcomes.
| Identifer | oai:union.ndltd.org:VANDERBILT/oai:VANDERBILTETD:etd-11112016-144712 |
| Date | 21 November 2016 |
| Creators | Cheng, Alex Chih-Ray |
| Contributors | Laurie Novak, Daniel Fabbri, Mia Levy |
| Publisher | VANDERBILT |
| Source Sets | Vanderbilt University Theses |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.vanderbilt.edu/available/etd-11112016-144712/ |
| Rights | restricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to Vanderbilt University or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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