Using Shared Decision-Making Tools and Patient-Clinician Conversations About Costs

Suárez, Nataly R. Espinoza; LaVecchia, Christina M.; Ponce, Oscar J.; Fischer, Karen M.; Wilson, Philip; Kamath, Celia C.; LeBlanc, Annie; Montori, Víctor M.; Brito, Juan P.

doi:10.1016/j.mayocpiqo.2020.04.013

Cited by 20 publications

(19 citation statements)

References 27 publications

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“…Use of the SDM encounter tool was associated with a 10-fold increase in the odds of having a cost conversation during the encounter, a finding consistent with prior studies. 10 , 11 While it is unclear how the Anticoagulation Choice SDM encounter tool may have supported cost conversations, it is possible that the cost content included in the tool, which highlighted the difference in out-of-pocket costs between warfarin and DOACs, helped at least identify cost as an important issue for patients with AF. It is also possible that the SDM tool prompted clinicians in general to more frequently ask about patient preferences, of which cost was one factor; patients using the tool also had more conversations about bleeding, anticoagulation treatment routine, reversing anticoagulation treatment, and diet/drug interactions.…”

Section: Discussionmentioning

confidence: 99%

“…Multivariable mixed-effects logistic regression included independent variables found to be significant in bivariate analysis and additional variables purported to influence conversations on costs (eg, income, education, marital status). 11 , 26 , 27 We also tested univariate associations between the occurrence of cost conversation in the encounter and (1) the choice of anticoagulation agent, and (2) whether or not cost was a factor in medication decision-making. We used SAS software version 9.4 (SAS Institute) to conduct the analyses.…”

Section: Methodsmentioning

confidence: 99%

“…These cost conversations during the clinical encounter may enable patients to make choices more closely aligned with their personal financial circumstances and preferences. Except for 2 studies, one in surgical patients 10 and another in patients with several medical conditions, 11 there is limited research on the ability of SDM tools to promote and support conversations about treatment costs.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Patient-clinician discussions about treatment costs can help lower costs of care and reduce financial toxicity [ 1 ]. Patients welcome opportunities to discuss treatment costs with their clinicians [ 9 , 12 ], but few patients and clinicians engage in cost conversations in routine practice [ 13 – 15 ]. As a result, many patients with prostate cancer pay more for their treatment than they expected [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Cost talk: protocol for a stepped-wedge cluster randomized trial of an intervention helping patients and urologic surgeons discuss costs of care for slow-growing prostate cancer during shared decision-making

Politi

Forcino

Parrish

et al. 2021

Trials

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Background Costs of care are important to patients making cancer treatment decisions, but clinicians often do not feel prepared to discuss treatment costs. We aim to (1) assess the impact of a conversation-based decision aid (Option Grid) containing cost information about slow-growing prostate cancer management options, combined with urologic surgeon training, on the frequency and quality of patient-urologic surgeon cost conversations, and (2) examine the impact of the decision aid and surgeon training on decision quality. Methods We will conduct a stepped-wedge cluster randomized trial in outpatient urology practices affiliated with a large academic medical center in the USA. We will randomize five urologic surgeons to four intervention sequences and enroll their patients with a first-time diagnosis of slow-growing prostate cancer independently at each period. Primary outcomes include frequency of cost conversations, initiator of cost conversations, and whether or not a referral is made to address costs. These outcomes will be collected by patient report (post-visit survey) and by observation (audio-recorded clinic visits) with consent. Other outcomes include the following: patient-reported decisional conflict post-visit and at 3-month follow-up, decision regret at 3-month follow-up, shared decision-making post-visit, communication post-visit, and financial toxicity post-visit and at 3-month follow-up; clinician-reported attitudes about shared decision-making before and after the study, and feasibility of sustained intervention use. We will use hierarchical regression analysis to assess patient-level outcomes, including urologic surgeon as a random effect to account for clustering of patient participants. Discussion This study evaluates a two-part intervention to improve cost discussions between urologic surgeons and patients when deciding how to manage slow-growing prostate cancer. Establishing the effectiveness of the strategy under study will allow for its replication in other clinical decision contexts. Trial registration ClinicalTrials.govNCT04397016. Registered on 21 May 2020

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“… 28 Previously, we have shown that SDM tools that incorporate cost information increased the incidence of cost conversations. 29 Encounters supported by decisions aids had 8 times higher odds of having cost conversations than encounters not supported by SDM tools. 29 This project builds on those findings by examining the impacts that cost conversations, whether supported or not by SDM tools, have on decision-making outcomes.…”

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confidence: 97%

Impact of Cost Conversation on Decision-Making Outcomes

Suárez

LaVecchia

Fischer

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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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

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Using Shared Decision-Making Tools and Patient-Clinician Conversations About Costs

Cited by 20 publications

References 27 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

Cost talk: protocol for a stepped-wedge cluster randomized trial of an intervention helping patients and urologic surgeons discuss costs of care for slow-growing prostate cancer during shared decision-making

Impact of Cost Conversation on Decision-Making Outcomes

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