Background. The American Society of Clinical Oncology views patient‐physician discussion of costs as a component of high‐quality care. Few data exist on patients’ views regarding how cost should be addressed in the clinic. Methods. We distributed a self‐administered, anonymous, paper survey to consecutive patients with breast cancer presenting for a routine visit within 5 years of diagnosis at an academic cancer center. Survey questions addressed experience and preferences concerning discussions of cost and views on cost control. Results are primarily descriptive, with comparison among participants on the basis of disease stage, using chi‐square and Fisher's exact tests. All p values are two‐sided. Results. We surveyed 134 participants (response rate 86%). Median age was 61 years, and 28% had stage IV disease. Although 44% of participants reported at least a moderate level of financial distress, only 14% discussed costs with their doctor; 94% agreed doctors should talk to patients about costs of care. Regarding the impact of costs on decision making, 53% felt doctors should consider direct costs to the patient, but only 38% felt doctors should consider costs to society. Moreover, 88% reported concern about costs of care, but there was no consensus on how to control costs. Conclusion. Most breast cancer patients want to discuss costs of care, but there is little consensus on the desired content or goal of these discussions. Further research is needed to define the role of cost discussions at the bedside and how they will contribute to the goal of high‐quality and sustainable cancer care.
6551 Background: The American Society of Clinical Oncology has suggested that patient-physician discussion of costs is a component of high quality care. Little data exists on patients’ experience confronting costs or attitudes on how cost should be addressed. Methods: We distributed a self-administered anonymous paper survey to consecutive patients with breast cancer presenting for a routine visit within 5 years of diagnosis at an academic center. Survey questions addressed financial distress, experience and preferences concerning discussions of cost, and views on cost control. Results are primarily descriptive, with comparison among patients on the basis of disease stage using Fisher’s exact test. All p-values are 2-sided. Results: We surveyed 134 patients (response rate 86%). Median age was 61. 72% stage I-III disease, and 28% (n=36) had stage IV disease. 44% (n=57) reported at least a moderate level of financial distress. Only 14% (n=18) reported ever discussing costs with their doctor, though 94% (n=121) felt doctors should talk to patients about costs. 53% (n=69) felt doctors should discuss direct costs with patients but only 38% (n=49) felt doctors should consider costs to society or insurance companies in their decision-making. Patients with metastatic disease were significantly less likely than those with earlier stage disease to want doctors to consider societal costs (33% (n=24) vs 6% (n=2), p<0.01). 88% (n=114) reported concern over costs of cancer care, but there was no consensus on how to control costs. Only 3% (n=4) favored greater cost sharing and 9% (n=11) supported greater means testing. A minority (33%, n=43) supported reducing drug costs through government price controls (33% n=43). The majority endorsed generic substitution (59%, n=75) and preferential selection of drugs which prolong survival 53% (n=69). Conclusions: Although many patients with breast cancer want to discuss costs of care with their doctors, there is little consensus on the ideal content of these discussions. Few patients support consideration of societal costs in clinical decision-making. Further research is needed to evaluate the potential for patient-physician discussions of cost to contribute to affordable high quality cancer care.
QUESTION ASKED: Because the cost of oncologic care is perpetually rising, we wanted to know how often physicians who treat cancer discuss the cost of care (both out-of-pocket and societal) with their patients, what the nature of those discussions is, and whether such discussions affect treatment decisions.SUMMARY ANSWER: Sixty percent of responding physicians reported addressing costs frequently or always in clinic, 40% addressed costs rarely or never, and 36% did not believe it is the doctor's responsibility to explain costs of care to patients. Additional responses are listed in Table 3. The majority of physicians feel their patients are not well informed about costs. "I don't know enough/lack of resources" is the largest reported barrier to cost discussions, and those who reported frequent discussions were significantly more likely to explain costs and to prioritize treatments in terms of cost. METHODS:A 15-question, study-specific, self-administered anonymous survey was sent electronically to a randomly selected sample of 2,290 ASCO physician members.BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Our overall response rate was somewhat low at 15%, with an adjusted response rate of 25% after adjusting for nonpracticing physician ASCO members. This increased the potential for selection bias, by which the respondents to this survey may not represent the true beliefs and practices of medical, radiation, and surgical oncologists. REAL-LIFE IMPLICATIONS:Our study offers a current snapshot of the frequency, nature, and attitudes toward cost discussions among medical, radiation, and surgical oncologists and their patients. Although the majority of responding physicians seem to agree that such discussions are legitimate-and arguably necessary-components of quality cancer care, there remains a substantial proportion who do not discuss costs nor feel it is their duty. Few believe they have adequate resources to discuss costs, suggesting that greater cost transparency, education concerning costs of care, tools to facilitate discussions, and validated interventions are needed. We surveyed US cancer doctors to examine current attitudes toward cost discussions and how they influence decision making and practice management. MethodsWe conducted a self-administered, anonymous, electronic survey of randomly selected physician ASCO members to evaluate the frequency and nature of cost discussions reported by physicians, attitudes toward discussions of cost in clinics, and potential barriers. ResultsA total of 333 of 2,290 physicians responded (response rate [RR], 15%; adjusted RR after omitting nonpracticing physician ASCO members, 25%), Respondent practice settings were 45% academic and 55% community/private practice. Overall, 60% reported addressing costs frequently/always in clinic, whereas 40% addressed costs rarely/never. The largest reported barrier was lack of resources to guide discussions. Those who reported frequent discussions were significantly more likely to prioritize treatments in terms of cost and believed doctors shoul...
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