Conversation About Financial Issues in Routine Oncology Practices: A Multicenter Study
Conversation About Financial Issues in Routine Oncology Practices: A Multicenter Study
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DOI：
10.1200/jop.18.00618
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发表时间：
2019-08-01
影响因子：
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通讯作者：
Tilburt, Jon C.
中科院分区：
文献类型：
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作者：
Warsame, Rahma;Kennedy, Cassie C.;Tilburt, Jon C.
我们回顾了2012年5月3日至2014年9月23日之间的529个音频记录，这些音频记录来自一项前瞻性的三点交流研究，在该研究中，在任何实体瘤恶性肿瘤的任何管理阶段的患者都被视为常规肿瘤预约。录音被去识别，转录，并标记任何提到的费用。我们编码的遭遇，并使用定性专题分析。结果金融问题进行了讨论，在151（28%）的529录音。谈话平均持续不到2分钟。患者/护理人员提出了大多数的讨论（151人中的106人），40%的患者/护理人员提出的费用问题没有得到临床医生的口头承认。社会服务转介只有6次。内容分析的主题与保险资格/过程，工作不安全，药物成本，作为影响医疗决策的工具的成本，医疗保健的具体成本和基本需求。财务问题通过测试或药物覆盖否认影响肿瘤学工作流程，为临床医生创建文书工作，可能影响患者参与试验，并导致药物自我配给或类似行为。通常情况下，财务问题与负面emotions.CONCLUSION财务问题提出了约四分之一的学术肿瘤学访问。这些简短的对话通常由患者/护理人员发起，临床医生经常不加处理，似乎会影响医疗决策和工作流程，并导致痛苦。确定的主题揭示了必须解决的差距，以帮助癌症患者科普不断上升的护理成本。(C)2019年美国临床肿瘤学会
PURPOSE To describe the frequency, content, dynamics, and patterns of cost conversations in academic medical oncology across tumor types.PATIENTS AND METHOS We reviewed 529 audio recordings between May 3, 2012, to September 23, 2014, from a prospective three-site communication study in which patients at any stage of management for any solid tumor malignancy were seen in routine oncology appointments. Recordings were deidentified, transcribed, and flagged for any mention of cost. We coded encounters and used qualitative thematic analysis.RESULTS Financial issues were discussed in 151 (28%) of 529 recordings. Conversations lasted shorter than 2 minutes on average. Patients/caregivers raised a majority of discussions (106 of 151), and 40% of cost concerns raised by patients/caregivers were not verbally acknowledged by clinicians. Social service referrals were made only six times. Themes from content analysis were related to insurance eligibility/process, work insecurity, cost of drugs, cost used as tool to influence medical decision making, health care-specific costs, and basic needs. Financial concerns influenced oncology work processes via test or medication coverage denials, creating paperwork for clinicians, potentially influencing patient involvement in trials, and leading to medication self-rationing or similar behaviors. Typically, financial concerns were associated with negative emotions.CONCLUSION Financial issues were raised in approximately one in four academic oncology visits. These brief conversations were usually initiated by patients/caregivers, went frequently unaddressed by clinicians, and seemed to influence medical decision making and work processes and contribute to distress. Themes identified shed light on the kinds of gaps that must be addressed to help patients with cancer cope with the rising cost of care. (C) 2019 by American Society of Clinical Oncology