Encounter Decision Aids Can Prompt Breast Cancer Surgery Cost Discussions: Analysis of Recorded Consultations

Mary C. Politi, Renata W. Yen, Glyn Elwyn, Natasha Kurien, Sophie G. Czerwinski, Danielle Schubbe, Catherine H. Saunders and Marie-Anne Durand
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Mary C. Politi: Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
Renata W. Yen: Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
Glyn Elwyn: Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
Natasha Kurien: Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
Sophie G. Czerwinski: Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
Danielle Schubbe: Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
Catherine H. Saunders: Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
Marie-Anne Durand: Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA

Medical Decision Making, 2020, vol. 40, issue 1, 62-71

Abstract: Background. Patients frequently worry about care costs, but clinicians seldom address the topic. Cost information is not typically included in patient decision aids (DAs). We examined whether including cost information in an encounter DA, with clinician training, influenced cost conversations. Method. As part of a larger trial, 14 surgeons from 4 cancer centers were randomized to 1 of 3 interventions: (1) Picture Option Grid DA that included a prompt to discuss relative treatment costs, hereafter called “cost prompt group†; (2) a text-only Option Grid DA that did not include cost information; (3) usual care. Groups 2 and 3 hereafter are referred to as “non-cost prompt groups.†Adult (18+) female patients, with stages I-IIIA breast cancer, eligible for both breast-conserving surgery and mastectomy were included. We gave surgeons feedback about adherence to the study protocol at 3, 6, and 12-months. We adapted a checklist to code the content of the audio-recorded clinical encounters. Results. 424/622 (68%) patients consented; 311 (73%) were eligible and successfully recorded (143 in the cost prompt group, 168 in the non-cost prompt groups). Costs were discussed in 132/311 (42.4%) encounters, and occurred more often in the cost prompt versus non-cost prompt groups (66.7% versus 33.3%; p

Keywords: care costs; financial toxicity; patient decision aids; shared decision-making (search for similar items in EconPapers)
Date: 2020
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:40:y:2020:i:1:p:62-71

DOI: 10.1177/0272989X19893308

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