Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS): prospective cohort study protocol

Teo, Irene; Singh, Ratna; Malhotra, Chetna; Özdemir, Semra; Dent, Rebecca; Kumarakulasinghe, Nesaretnam Barr; Yeo, Wee‐Song; Cheung, Yin Bun; Malhotra, Rahul; Kanesvaran, Ravindran; Yee, Alethea; Chan, Noreen; Wu, Huei Yaw; Chin, Soh Mun; Allyn, Hum Yin Mei; Yang, Grace Meijuan; Neo, Patricia Soek Hui; Nadkarni, Nivedita; Harding, Richard; Finkelstein, Eric A.

doi:10.1186/s12885-018-4356-z

Cited by 32 publications

(48 citation statements)

References 33 publications

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“…The current cross-sectional study utilises baseline data from family caregivers of advanced cancer patients from a cohort project described elsewhere 16. This study included informal family caregivers of patients with a diagnosis of advanced (stage IV) solid tumour malignancy where patient-caregiver dyads completed a self-report assessment.…”

Section: Methodsmentioning

confidence: 99%

Family caregivers of advanced cancer patients: self-perceived competency and meaning-making

Teo

Baid

Özdemir

et al. 2019

BMJ Support Palliat Care

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BackgroundFamily caregivers of patients with advanced cancer have been reported to provide long hours of care and be at risk for poor psychological outcomes. Although research has focused on the nature of caregiving burden, little attention has been paid to identifying protective factors that improve caregiver psychological outcomes.AimWe examined the relationship between caregivers’ time spent caregiving and the following psychological outcomes: anxiety, depression and caregiving esteem. Subsequently, we explored the main and moderating effects of caregiver-perceived self-competency and sense of meaning on caregiver psychological outcomes.Design/participantsCross-sectional analysis was conducted using the baseline data from an ongoing cohort study. Family caregivers of advanced cancer patients (n=287) were recruited from two tertiary hospitals in Singapore.ResultsTime spent caregiving was not significantly associated with caregiver anxiety, depression or caregiving esteem. However, significant main effects of self-competency on anxiety and caregiving esteem; and sense of meaning on anxiety, depression and caregiving esteem were observed. Moderator analyses further indicated that self-competency attenuated the positive relationship between time spent caregiving and anxiety, while sense of meaning attenuated the negative relationship between time spent caregiving and caregiving esteem.ConclusionGreater perceived self-competency and sense of meaning are related to better caregiver psychological outcomes, and protect caregivers from worsening outcomes as caregiving hours increase. Our findings suggest that screening caregivers for distress is an important part of care, and that supportive interventions for caregivers should aim to enhance their perceived caregiving competencies and the ability to make meaning of their caregiving role.

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Section: Methodsmentioning

confidence: 99%

Family caregivers of advanced cancer patients: self-perceived competency and meaning-making

Teo

Baid

Özdemir

et al. 2019

BMJ Support Palliat Care

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“…COMPASS is a prospective, longitudinal study of advanced cancer patients in Singapore. 19 The study was designed to capture patients’ healthcare utilization, associated costs, perceptions of the quality of care, and quality of life. Participants were requested to complete baseline and tri-monthly surveys.…”

Section: Methodsmentioning

confidence: 99%

End-of-life cost trajectories and the trade-off between treatment costs and life-extension: Findings from the Cost and Medical Care of Patients with Advanced Serious Illness (COMPASS) cohort study

et al. 2021

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Background: Few studies have assessed how patient preferences influence end-of-life costs. Aim: To estimate mean monthly healthcare costs in 2019 Singapore Dollars (SGD) at five time points within the last year of life and identify how patients’ preferences for the trade-off between treatment cost containment and life-extension and other factors affect these costs. Design: Mean monthly costs were quantified in the last 1, 3, 6, 9, and 12-months before death. Univariate and multivariate analyses were conducted. Setting/participants: Billing records for 286 deceased participants in the Cost and Medical Care of Patients with Advanced Serious Illness (COMPASS) cancer cohort study in Singapore. Results: Mean monthly costs were $5140 (95% CI: $4750; $5520) in the 12-months before death and rose to $8350 (95% CI: $7110; $9590) 1-month before death. Participants preferring higher cost containment/less life-extension defied the trend of increasing costs closer to death (mean monthly costs of $4630 (95% CI: $3690; $ 5580) and $4850 (95% CI: $2850; $6850) (12-months and 1-month before death respectively). Participants preferring lower cost containment/more life-extension had costs that were $1050 (95% CI: $49; $2051) and $5220 (95% CI: $2320; $8130) higher than those preferring lower costs/less life-extension 12-months and 1-month before death respectively. Conclusions: On average, cancer patients in Singapore can expect to spend $61,680 in the last year of life. Of broader relevance is that patient preferences and other observable factors clearly influence these costs, suggesting that policymakers and patients can better predict and budget for end-of-life costs by considering these factors.

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“…We either used standardized translations for all validated scales in the survey or translated and backtranslated these scales according to developers' instructions. Details of the study have been published 5,21 . The current analyses used follow‐up data of up to 2 years.…”

Section: Methodsmentioning

confidence: 99%

“…Details of the study have been published. 5,21 The current analyses used follow-up data of up to 2 years.…”

Section: Study Setting and Designmentioning

confidence: 99%

Experiences with health care practitioners among advanced cancer patients and their family caregivers: A longitudinal dyadic study

Malhotra

Chaudhry

Özdemir

et al. 2021

Cancer

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and for the COMPASS Study Group BACKGROUND: Assessing patient and caregiver experiences with care is central to improving care quality. The authors assessed variations in the experiences of advanced cancer patients and their caregivers with physician communication and care coordination by patient and caregiver factors. METHODS: The authors surveyed 600 patients with a stage IV solid malignancy and 346 caregivers every 3 months for more than 2 years. Patients entered the cohort any time during their stage IV trajectory. The analytic sample was restricted to patient-caregiver dyads (n = 299). Each survey assessed patients' experiences with physician communication and care coordination; patients' symptom burden; caregivers' quality of life; and patients' and caregivers' anxiety, financial difficulties, and perceptions of treatment goals. An actor-partner interdependence framework was used for analysis. RESULTS: Patients reported better physician communication (average marginal effect [AME], 6.04; 95% confidence interval [CI], 3.82 to 8.26) and care coordination (AME, 8.96; 95% CI, 6.94 to 10.97) than their caregivers. Patients reported worse care coordination when they (AME, -0.56; 95% CI, -1.07 to -0.05) or their caregivers (AME, -0.58; 95% CI, -0.97 to -0.19) were more anxious. Caregivers reported worse care coordination when they were anxious (AME, -1.62; 95% CI, -2.02 to -1.23) and experienced financial difficulties (AME, -2.31; 95% CI, -3.77 to -0.86). Correct understanding of the treatment goal (vs being uncertain) was associated with caregivers reporting physician communication as better (AME, 3.67; 95% CI, 0.49 to 6.86) but with patients reporting it as worse (AME, -3.29; 95% CI, -6.45 to -0.14). CONCLUSIONS: Patients' and caregivers' reports of physician communication and care coordination vary with aspects of their own and each other's well-being and with their perceptions of treatment goals. These findings may have implications for improving patients' and caregivers' reported experiences with health care practitioners.

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Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS): prospective cohort study protocol

Cited by 32 publications

References 33 publications

Family caregivers of advanced cancer patients: self-perceived competency and meaning-making

Family caregivers of advanced cancer patients: self-perceived competency and meaning-making

End-of-life cost trajectories and the trade-off between treatment costs and life-extension: Findings from the Cost and Medical Care of Patients with Advanced Serious Illness (COMPASS) cohort study

Experiences with health care practitioners among advanced cancer patients and their family caregivers: A longitudinal dyadic study

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