Impact of Cost Conversation on Decision-Making Outcomes

Abstract

Objective: To understand the impact of cost conversations on the following decision-making outcomes: patients' knowledge about their conditions and treatment options, decisional conflict, and patient involvement.Patients and Methods: In 2020 we performed a secondary analysis of a randomly selected set of 220 video recordings of clinical encounters from trials run between 2007 and 2015. Videos were obtained from eight practice-based randomized trials and one preepost-prospective study comparing care with and without shared decision-making (SDM) tools. Results: The majority of trial participants were female (61%) and White (86%), with a mean age of 56, some college education (68%), and an income greater than or equal to $40,000 per year (75%), and who did not participate in an encounter aided by an SDM tool (52%). Cost conversations occurred in 106 encounters (48%). In encounters with SDM tools, having a cost conversation lead to lower uncertainty scores (2.1 vs 2.6, P¼.02), and higher knowledge (0.7 vs 0.6, P¼.04) and patient involvement scores (20 vs 15.7, P¼.009) than in encounters using SDM tools where cost conversations did not occur. In a multivariate model, we found slightly worse decisional conflict scores when patients started cost conversations as opposed to when the clinicians started cost conversations. Furthermore, we found higher levels of knowledge when conversations included indirect versus direct cost issues. Conclusion: Cost conversations have a minimal but favorable impact on decision-making outcomes in clinical encounters, particularly when they occurred in encounters aided by an SDM tool that raises cost as an issue.KeywordsCost conversations; shared decision making; decision-making

Financial Toxicity in the Clinical Encounter: A Paired Survey of Patient and Clinician Perceptions

“…We had previously conducted 3 studies showing that cost conversations have a minimal but favorable effect on decision-making but not on cost-reducing outcomes in clinical encounters, particularly when they occur in encounters aided by a shared decision-making tool. 5 Further cost conversations were associated with patients’ consideration of treatment cost burden but not the final treatment choice. 6 We also found that using shared decision-making tools that raise cost as an issue increased the occurrence of cost conversations but were less likely to address cost issues or offer potential solutions to patients’ cost concerns.…”

2023 Update in ambulatory general internal medicine

“…3 A discussion on the potential benefi ts, risks, and cost, as suggested in the article, would be valuable in guiding clinical decisions. 4 Furthermore, the authors provide an excellent overview of diet as secondary prevention, particularly emphasizing the superiority of a Mediterranean diet over a low-fat diet. However, it might be pertinent to explore the feasibility and accessibility of such dietary recommendations for patients, considering cultural and socioeconomic factors.…”