How, When, and With Whom Should Cost of Care Conversations Occur? Preferences of Two Distinct Cancer Survivor Groups

Abstract

PURPOSE: Cost of care (CoC) conversations should occur routinely in oncology practice. However, patient preferences about with whom, when, and how to have these conversations are missing and preferences may vary across patient populations. METHODS: We performed a secondary qualitative analysis of quotes from interviews with 28 cancer survivors from two health care settings (Kaiser Permanente Washington and O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham [UABCCC]). A targeted approach searched for three constructs: (1) Who should have CoC conversations with patients? (2) When should CoC conversations occur? and (3) How should CoC conversations happen? RESULTS: Interviewees were similar in age and education, but UABCCC participants had more racial/ethnic minority representation and financial distress. Within each construct, themes were similar across both groups. As to who should have CoC conversations, we found that (1) providers’ main role is medical care, not CoC; and (2) care team staff members are a more appropriate choice to address CoC needs. About the question of when, we found that (3) individuals have strong convictions about when and if they want to discuss CoC; and (4) CoC information and resources need to be available when patients are ready. About the question of how, themes were (5) provide estimates of anticipated out-of-pocket costs and insurance coverage; (6) provide reassurance, sympathy, and concrete solutions; and (7) because of their sensitivity, conduct CoC conversations in a comfortable, private space. CONCLUSION: These findings offer general guidance as to who should conduct CoC conversations and when and how they should occur, with applicability across different patient populations.

Greater financial toxicity relates to greater distress and worse quality of life among breast and gynecologic cancer survivors

“…43 Pisu et al outline survivor recommendations for cost of care conversations, which may extend to financial screening within oncology practice. 44 Our findings suggest survivors at all stages of the cancer trajectory and income levels may experience financial stress; aligned with recommendations that financial screening and education should be initiated early, with regular follow up assessment as treatment costs and needs may change. 45,46 Integrating an electronic finance-related patient reported outcomes measure as a routine part of care may facilitate screening, prompt cost-related discussions, and guide referrals to resources; with administration at key transition points through the patient's journey (e.g., at diagnosis, mid-way, and end of treatment, if there is a change in treatment, or recurrence).…”

“…[49][50][51] Further research is needed to test the efficacy of resources and interventions, along with implementation and dissemination strategies. 44 Many survivors report a desire to talk to their providers about the financial impact of cancer but these discussions rarely occur. 52 Although there are multiple stakeholders (e.g., providers, institutions, payers, pharmaceutical, and device manufacturers) that play key roles in finding solutions to the high costs of cancer care and, undoubtedly, system-level changes are needed, patientcentered interventions may go a long way in addressing survivor financial distress.…”

“…Pisu et al. outline survivor recommendations for cost of care conversations, which may extend to financial screening within oncology practice 44 …”

Accuracy of Physician Estimates of Out-of-Pocket Costs for Medication Filling

“…Such cost-sharing mechanisms exist to address moral hazard and prevent overconsumption of medical resources, but their complexity often confuses patients, 13 who turn to their clinicians for assistance. 14 , 15 , 16 , 17 , 18 , 19 , 20 Although patients may not expect clinicians to have all the answers, they do report hoping for changes in prescription patterns or referrals to pharmaceutical assistance programs when out-of-pocket costs are projected to be high. 21 , 22 …”

How palliative care teams can mitigate financial toxicity in cancer care

“…One of us (TJS) uses the simple question: “Are you have difficulty paying for your care?” The Cost Conversation project of Avalere Health and the Robert Wood Johnson Foundation also give practical tips [ 27 ], and there are published screening tools [ 26 ]. Interviews of patients suggest that the cost of care conversations should be held in a private place, with emotional support, and with someone who understands and can help [ 28 ]. When patients at risk are identified, medical oncologists and all members of the cancer care team should be alerted, and careful deliberation is made to provide patient-centered care that does not cause financial ruin.…”