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Enderson Miranda

DPhil thesis:

A mixed-methods study of the impact of value-based health care systems on the appropriateness of treatment received by patients with advanced cancer.

Research abstract

A major opportunity exists for the development and application of improved care algorithms and pathways that better identify when patients with metastatic cancer should stop receiving active aggressive treatment. The overarching aim of my DPhil research is to explore whether potentially excessive or harmful treatments for patients with advanced cancer may be avoided by implementing a value-based health care system.  There are three specific aims under the overarching objective: (1) to describe qualitatively and to quantify the range of treatments used at the end-of-life, (2) to analyze individual patient, family, and caregiver preferences on treatment towards the end of life, gaining a deeper understanding of how appropriateness of treatment is defined and by whom, and (3) to evaluate the impact of different models of care and the implementation of an integrated value-based health care system in the appropriateness of treatment received by patients with advanced cancer.  My DPhil proposal suggests a Convergent Parallel Mixed-Methods Design, in which observational studies are conducted concurrently with qualitative interviews and focus groups. This approach integrates qualitative and quantitative methodologies to close the gap between what can be quantified and what cannot be counted, such as preferences for end-of-life care. 


Dr. Clare Bankhead 

Dr. Marcy McCall McBain

Dr. David Nunan