Interventions supporting cost conversations between patients and clinicians: A systematic review

Barrera, Francisco J.; Ponce, Oscar J.; Suárez, Nataly R. Espinoza; Alvarez‐Villalobos, Neri Alejandro; Zuñiga-Hernandez, Jorge A; Prokop, Larry J.; Gionfriddo, Michael R.; Rodríguez-Gutiérrez, René; Brito, Juan P.

doi:10.1111/ijcp.14037

Cited by 5 publications

(6 citation statements)

References 26 publications

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“…In addition, more attention should be given to developing evidence-based interventions to support cost conversations, given that very few have been tested. 33 Finally, we found that the occurrence of cost conversations was associated with patients who reported that cost was an important factor in their selection of anticoagulant. However, the actual choice of medication was not significantly correlated with the incidence of cost conversations, suggesting that either these conversations were not productive or consequential, or that considerations other than drug costs (eg, satisfaction with the existing regiment or the need to avoid diet restrictions or periodic monitoring) were more important in selecting an anticoagulation agent.…”

Section: Jama Network Open | Cardiologymentioning

confidence: 83%

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Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians

Kamath¹,

Giblon²,

Kunneman³

et al. 2021

JAMA Netw Open

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IMPORTANCE How patients with atrial fibrillation (AF) and their clinicians consider cost in forming care plans remains unknown. OBJECTIVE To identify factors that inform conversations regarding costs of anticoagulants for treatment of AF between patients and clinicians and outcomes associated with these conversations. DESIGN, SETTING, AND PARTICIPANTS This cohort study of recorded encounters and participant surveys at 5 US medical centers (including academic, community, and safety-net centers) from the SDM4AFib randomized trial compared standard AF care with and without use of a shared decisionmaking (SDM) tool. Included patients were considering anticoagulation treatment and were

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Section: Jama Network Open | Cardiologymentioning

confidence: 83%

“…This hypothesis should be explored further. In addition, more attention should be given to developing evidence-based interventions to support cost conversations, given that very few have been tested …”

Section: Discussionmentioning

confidence: 99%

Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians

Kamath¹,

Giblon²,

Kunneman³

et al. 2021

JAMA Netw Open

Self Cite

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“…In 2009 the American Society of Clinical Oncology endorsed cost communication between patients and providers [9]. Despite this, patient preferences and values have mainly centered on the clinical experience of care (e.g., side effects, comorbidities of treatment); to date, the costs of care and their implications have not been widely included in shared cancer treatment decisions [38,39]. In a survey of over 600 women with breast cancer, Greenup et al found that 78% never discussed costs with their cancer team [23].…”

Section: Patient Cost Preferences and Values In Cancer Carementioning

confidence: 99%

Navigating the High Costs of Cancer Care: Opportunities for Patient Engagement

2021

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Over the past decade, the financial burden of cancer care on patients and their families has garnered increased attention. Many of the potential solutions have focused on system-level interventions such as adopting value-based payment models and negotiating drug prices; less consideration has been given to actions at the patient level to address cancer care costs. We argue that it is imperative to develop and support patient-level strategies that engage patients and consider their preferences, values and individual circumstances. Opportunities to meet these aims and improve the economic experience of patients in oncology are discussed, including: shared decision-making and communication, financial navigation and treatment planning, digital technology and alternative care pathways, and value-based insurance design.

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“…15 Yet clinician communication and patient decision aids rarely include costs of treatment options to support decisions. 16 Although financial toxicity affects patients with cancer worldwide, [1][2][3][4][5] it is particularly a problem for patients in the United States.…”

Section: Introductionmentioning

confidence: 99%

“…Patients want to know about cost information 13,14 and clinicians acknowledge its importance and impact on patients' choices and adherence to care 15 . Yet clinician communication and patient decision aids rarely include costs of treatment options to support decisions 16 …”

Section: Introductionmentioning

confidence: 99%

The impact of adding cost information to a conversation aid to support shared decision making about low‐risk prostate cancer treatment: Results of a stepped‐wedge cluster randomised trial

Politi

Forcino

Parrish

et al. 2023

Health Expectations

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BackgroundDecision aids help patients consider the benefits and drawbacks of care options but rarely include cost information. We assessed the impact of a conversation‐based decision aid containing information about low‐risk prostate cancer management options and their relative costs.MethodsWe conducted a stepped‐wedge cluster randomised trial in outpatient urology practices within a US‐based academic medical center. We randomised five clinicians to four intervention sequences and enroled patients newly diagnosed with low‐risk prostate cancer. Primary patient‐reported outcomes collected postvisit included the frequency of cost conversations and referrals to address costs. Other patient‐reported outcomes included: decisional conflict postvisit and at 3 months, decision regret at 3 months, shared decision‐making postvisit, financial toxicity postvisit and at 3 months. Clinicians reported their attitudes about shared decision‐making pre‐ and poststudy, and the intervention's feasibility and acceptability. We used hierarchical regression analysis to assess patient outcomes. The clinician was included as a random effect; fixed effects included education, employment, telehealth versus in‐person visit, visit date, and enrolment period.ResultsBetween April 2020 and March 2022, we screened 513 patients, contacted 217 eligible patients, and enroled 117/217 (54%) (51 in usual care, 66 in the intervention group). In adjusted analyses, the intervention was not associated with cost conversations (β = .82, p = .27), referrals to cost‐related resources (β = −0.36, p = .81), shared decision‐making (β = −0.79, p = .32), decisional conflict postvisit (β = −0.34, p= .70), or at follow‐up (β = −2.19, p = .16), decision regret at follow‐up (β = −9.76, p = .11), or financial toxicity postvisit (β = −1.32, p = .63) or at follow‐up (β = −2.41, p = .23). Most clinicians and patients had positive attitudes about the intervention and shared decision‐making. In exploratory unadjusted analyses, patients in the intervention group experienced more transient indecision (p < .02) suggesting increased deliberation between visit and follow‐up.DiscussionDespite enthusiasm from clinicians, the intervention was not significantly associated with hypothesised outcomes, though we were unable to robustly test outcomes due to recruitment challenges. Recruitment at the start of the COVID‐19 pandemic impacted eligibility, sample size/power, study procedures, and increased telehealth visits and financial worry, independent of the intervention. Future work should explore ways to support shared decision‐making, cost conversations, and choice deliberation with a larger sample. Such work could involve additional members of the care team, and consider the detail, quality, and timing of addressing these issues.Patient or Public ContributionPatients and clinicians were engaged as stakeholder advisors meeting monthly throughout the duration of the project to advise on the study design, measures selected, data interpretation, and dissemination of study findings.

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Interventions supporting cost conversations between patients and clinicians: A systematic review

Cited by 5 publications

References 26 publications

Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians

Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians

Navigating the High Costs of Cancer Care: Opportunities for Patient Engagement

The impact of adding cost information to a conversation aid to support shared decision making about low‐risk prostate cancer treatment: Results of a stepped‐wedge cluster randomised trial

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