Physician–patient communication regarding patients’ healthcare costs in the US: A systematic review of the literature

Meluch, Andrea L.; Oglesby, Willie H.

doi:10.1179/1753807615y.0000000010

Cited by 21 publications

(13 citation statements)

References 27 publications

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“…Last, we were unable to provide patients with an accurate estimate of their out‐of‐pocket cost during the shared decision‐making process, despite this issue being a significant factor for the majority of patients . Given the lack of comparative cost data available for the individual patient during a clinical encounter, further investigation is needed to determine how best to discuss cost at point‐of‐care .…”

Section: Discussionmentioning

confidence: 99%

Preference Phenotypes in Support of Shared Decision–Making at Point‐of‐Care for Patients With Rheumatoid Arthritis: A Proof‐of‐Concept Study

Hsiao

Binder-Finnema

Nowell

et al. 2019

Arthritis Care & Research

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Section: Discussionmentioning

confidence: 99%

Preference Phenotypes in Support of Shared Decision–Making at Point‐of‐Care for Patients With Rheumatoid Arthritis: A Proof‐of‐Concept Study

Hsiao

Binder-Finnema

Nowell

et al. 2019

Arthritis Care & Research

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“…Nevertheless, the randomization procedure of asking all patients to participate may still be considered a strength, mainly because patients were not preselected, with unknown insight into their current disease status. In addition, the final treatment choice was not assessed, which is a potential limitation, since better follow‐up as to whether the medication was approved by the insurance payor could have provided an accurate estimate of out‐of‐pocket costs during the SDM process . This qualitative exploration nevertheless offers a baseline for future studies on triangulated SDM in other settings to demonstrate coherence with and validate its findings .…”

Section: Discussionmentioning

confidence: 99%

Qualitative Exploration of Triangulated, Shared Decision‐Making in Rheumatoid Arthritis

Binder-Finnema

Dzurilla

Hsiao

et al. 2019

Arthritis Care & Research

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Objective. Treat-to-target implementation in rheumatoid arthritis (RA) requires a shared decision-making (SDM) process. However, ability to pay is a major determinant of patient choice, but how this factor affects SDM is underexplored.Methods. Visits at 4 RA clinics during which patients faced a decision to change their treatment were audiotaped between May 2016 and June 2017. Audiotapes were transcribed verbatim and analyzed using qualitative framework analysis.Results. A total of 156 visits were analyzed. Most patients with RA, except those with effective insurance coverage, had deliberations disrupted or sidelined by third-party insurance providers having power to authorize the preferred disease-modifying antirheumatic drug choice. This triangulated SDM complicated efficiency in deliberations and timely treatment and was a barrier to shared engagement about health risks and symptom improvement typically found in patient-provider dyads.Conclusion. Rheumatology care providers should aim to incorporate treatment costs and ability to pay into their deliberations so that individualized out-of-pocket estimates can be considered during triangulated SDM at the pointof-care.

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“…There is little published research on the impact of the Choosing Wisely campaign on public perceptions, although a smattering of evidence suggests that many Americans are now aware that particular tests or treatments may be unnecessary . Research on the public's understanding and preferences regarding the role of cost in clinical decisions, however, suggests that changing consumers’ attitudes and behaviors with respect to low‐value care may not be easy. Findings from this research on cost highlight several specific challenges for changing attitudes and expectations with respect to low‐value care.…”

Section: Conceptual Foundations: Consumer Messaging and Framingmentioning

confidence: 99%

Treating, Fast and Slow: Americans’ Understanding of and Responses to Low‐Value Care

Schlesinger

Grob

2017

Milbank Quarterly

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Effectively addressing low‐value care calls for engaging the public, including the one‐third of Americans who currently cannot envision benefits from avoiding low‐value care. Public awareness of and response to low‐value care can be enhanced through revised media messaging. These efforts are more effective if they emphasize health risks rather than the financial costs associated with unnecessary tests and treatments. Long‐term robust public support for addressing low‐value care may require shifting the focus from particular tests and treatments to emphasize, instead, the potential for better communication and more personalized attention if clinicians spend more time talking and less time testing. Context As much as 30% of US health care spending may be unnecessary. The Choosing Wisely campaign, now active in a dozen countries, addresses this problem in part through public education campaigns. This article explores Americans’ understanding of low‐value care in 2015, assesses the impact of media messaging, and tests alternative message framing. Methods We use a mixed‐methods design incorporating (1) 8 focus groups exploring Americans’ understanding of and language for low‐value care, (2) 48 intensive interviews with patients on their interactions with physicians regarding questions of cost and value, (3) a national survey of 920 respondents examining their awareness of low‐value care, and (4) a survey experiment with 785 participants, testing the impact of media messages on attitudes about low‐value care, treatment choices, and selection of a primary care clinician. Findings One‐third of Americans have difficulty envisioning benefits from avoiding low‐value care, a figure that increases to half for less educated and minority respondents. Most Americans who anticipate benefits hope that less testing and treatment will be replaced by more interactive and personalized care. Even without media priming, many Americans would avoid common forms of low‐value care like unnecessary antibiotics or excess imaging for lower back pain, but few favor clinicians who avoid these practices. Although the public's awareness and actions are increased and disparities are reduced by media messaging, conventional messages also exacerbate the blame placed on providers. Avoiding low‐value care is enhanced, blaming providers is reduced, and disparities are further diminished if messages put more emphasis on the health risks of these tests and treatments. Conclusions The public's awareness of low‐value care is incomplete, with substantial disparities related to race, ethnicity, and socioeconomic status. Media messaging can help fill these gaps but, in the short run, would be enhanced by fine‐tuning how low‐value care is characterized. In the longer run, building robust public support for reducing low‐value care may require refocusing attention away from specific tests and treatments and toward the relational benefits for patients if clinicians spent less time on testing and more time on personalized care.

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Physician–patient communication regarding patients’ healthcare costs in the US: A systematic review of the literature

Cited by 21 publications

References 27 publications

Preference Phenotypes in Support of Shared Decision–Making at Point‐of‐Care for Patients With Rheumatoid Arthritis: A Proof‐of‐Concept Study

Preference Phenotypes in Support of Shared Decision–Making at Point‐of‐Care for Patients With Rheumatoid Arthritis: A Proof‐of‐Concept Study

Qualitative Exploration of Triangulated, Shared Decision‐Making in Rheumatoid Arthritis

Treating, Fast and Slow: Americans’ Understanding of and Responses to Low‐Value Care

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