Understanding Patients' Attitudes Toward Communication About the Cost of Cancer Care
Understanding Patients' Attitudes Toward Communication About the Cost of Cancer Care
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DOI：
10.1200/jop.2011.000418
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发表时间：
2012-07-01
影响因子：
--
通讯作者：
Buss, Mary K.
中科院分区：
文献类型：
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作者：
Bullock, Andrea J.;Hofstatter, Erin W.;Buss, Mary K.
目的：最近的出版物促进了医生与患者在成本方面的沟通，作为减少肿瘤学总体支出和最小化患者经济负担的一种手段。没有研究评估患者对肿瘤学成本沟通的看法。我们试图描述肿瘤患者对成本沟通的态度，探讨潜在的预测患者的沟通偏好，并评估癌症患者如何考虑成本时，管理decisions.Methods：一个31项的问卷调查，以衡量肿瘤患者的沟通偏好，癌症护理的成本，重点是自付费用。项目尽可能改编自其他文书。试点后，患者从学术门诊肿瘤学实践中招募。结果：在771例患者中，256例应答（应答率33%）。大多数人（68%）更愿意在治疗前了解自付费用。大多数人（59%）希望他们的医生与他们讨论这些费用。虽然76%的人表示与医生讨论费用时感觉很舒服，但74%的人愿意与医生以外的人讨论费用。大多数患者在决策时没有考虑自付费用（57%）或国家的医疗保健费用（61%），他们也不认为他们的医生应该（55%）。接受积极化疗的患者不太可能想与他们的医生讨论自付费用（P <0.035）。结论：患者的舒适度和讨论癌症费用的愿望超过了肿瘤学家，这表明有必要对肿瘤学家进行这一重要主题的教育。患者希望了解治疗相关成本并不等同于希望成本影响医疗决策。
Purpose: Recent publications have promoted physician-patient communication on cost as a means of decreasing overall spending and minimizing patients' financial burden in oncology. No study has assessed patients' perspectives on cost communication in oncology. We sought to describe oncology patients' attitudes toward cost communication, explore potential predictors for patients' communication preferences, and assess how patients with cancer consider cost when making management decisions.Methods: A 31-item questionnaire was developed to measure oncology patients' communication preferences regarding the cost of cancer care, focusing on out-of-pocket costs. Items were adapted from other instruments when possible. After piloting, patients were recruited from an academic ambulatory oncology practice. Basic descriptive statistics were applied.Results: Of the 771 patients approached, 256 responded (response rate, 33%). Most (68%) preferred to know about outof-pocket costs before treatment. A majority (59%) wanted their physician to discuss these costs with them. Although 76% reported feeling comfortable discussing cost with their physician, 74% were amenable to discussing cost with someone other than their physician. Most patients did not consider out-of-pocket costs (57%) or the health care costs of the country (61%) in their decision making, nor did they believe their physician should (55%). Patients receiving active chemotherapy were less likely to want to discuss out-of-pocket costs with their physician (P < .035).Conclusion: Patients' comfort with and desire to discuss cancer costs exceed that of oncologists, suggesting a need to educate oncologists on this important topic. A patient's desire to understand treatment-associated cost does not equate with a desire for cost to influence medical decision making.