Encounter Decision Aids Can Prompt Breast Cancer Surgery Cost Discussions: Analysis of Recorded Consultations
Encounter Decision Aids Can Prompt Breast Cancer Surgery Cost Discussions: Analysis of Recorded Consultations
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DOI：
10.1177/0272989x19893308
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发表时间：
2019-12-12
影响因子：
3.6
通讯作者：
Durand, Marie-Anne
中科院分区：
文献类型：
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作者：
Politi, Mary C.;Yen, Renata W.;Durand, Marie-Anne
背景。患者经常担心护理费用，但临床医生很少谈及这个话题。成本信息通常不包括在患者决策辅助（DAs）。我们研究了在临床医生培训的情况下，在遭遇DA中包含成本信息是否会影响成本对话。方法。作为一项更大的试验的一部分，来自4个癌症中心的14名外科医生被随机分配到3种干预措施中的一种：(1)图片选项网格DA，包括提示讨论相对治疗成本，以下称为“成本提示组”；(2)不包含成本信息的纯文本Option Grid DA；(3)平时护理。第2组和第3组下文称为“非成本提示组”。成年（18岁以上）女性I-IIIA期乳腺癌患者，符合保乳手术和乳房切除术的条件。我们在3个月、6个月和12个月时向外科医生反馈对研究方案的依从性。我们改编了一份清单，对临床接触的录音内容进行编码。结果：424/622例（68%）患者同意；311例（73%）符合条件并成功记录（143例在成本提示组，168例在非成本提示组）。在132/311次（42.4%）会面中讨论了成本，并且在成本提示组中比在非成本提示组中更经常出现(66.7%对33.3%;p
Background. Patients frequently worry about care costs, but clinicians seldom address the topic. Cost information is not typically included in patient decision aids (DAs). We examined whether including cost information in an encounter DA, with clinician training, influenced cost conversations. Method. As part of a larger trial, 14 surgeons from 4 cancer centers were randomized to 1 of 3 interventions: (1) Picture Option Grid DA that included a prompt to discuss relative treatment costs, hereafter called "cost prompt group"; (2) a text-only Option Grid DA that did not include cost information; (3) usual care. Groups 2 and 3 hereafter are referred to as "non-cost prompt groups." Adult (18+) female patients, with stages I-IIIA breast cancer, eligible for both breast-conserving surgery and mastectomy were included. We gave surgeons feedback about adherence to the study protocol at 3, 6, and 12-months. We adapted a checklist to code the content of the audio-recorded clinical encounters. Results. 424/622 (68%) patients consented; 311 (73%) were eligible and successfully recorded (143 in the cost prompt group, 168 in the non-cost prompt groups). Costs were discussed in 132/311 (42.4%) encounters, and occurred more often in the cost prompt versus non-cost prompt groups (66.7% versus 33.3%; p