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Niehus H, Gunesch AN, Rodriguez N, Khoury J, Ma A, Gu N, Cao T, Muller M, Moriates C, Linker AS, Prochaska M, Fish D, Moulder G, Stephens M, Carney PA, Smeraglio A. Factors Associated with Medical Students' Attitudes About Cost-Conscious Care: A Mixed-Methods Multi-school Study. J Gen Intern Med 2024:10.1007/s11606-024-08783-x. [PMID: 38710863 DOI: 10.1007/s11606-024-08783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/22/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Because physician practices contribute to national healthcare expenditures, initiatives aimed at educating physicians about high-value cost-conscious care (HVCCC) are important. Prior studies suggest that the training environment influences physician attitudes and behaviors towards HVCCC. OBJECTIVE To explore the relationship between medical student experiences and HVCCC attitudes. DESIGN Quantitative and qualitative analysis of a multi-institutional survey. PARTICIPANTS Medical students from nine US medical schools. APPROACH A 44-item survey that included the Maastricht HVCCC Attitudes Questionnaire, a validated tool for assessing HVCCC attitudes, was administered electronically. Attitudinal domains of high-value care (HVC), cost incorporation (CI), and perceived drawbacks (PD) were compared using one-way ANOVA among students with a range of exposures. Open text responses inviting participants to reflect on their attitudes were analyzed using classical content analysis. KEY RESULTS A total of 740 students completed the survey (response rate 15%). Students pursuing a "continuity-oriented" specialty held more favorable attitudes towards HVCCC than those pursuing "technique-oriented" specialties (HVC sub-score = 3.20 vs. 3.06; p = 0.005, CI sub-score = 2.83 vs. 2.74; p < 0.001). Qualitative analyses revealed personal, educational, and professional experiences shape students' HVCCC attitudes, with similar experiences interpreted differently leading to both more and less favorable attitudes. CONCLUSION Students pursuing specialties with longitudinal patient contact may be more enthusiastic about practicing high-value care. Life experiences before and during medical school shape these attitudes, and complex interactions between these forces drive student perceptions of HVCCC.
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Affiliation(s)
- Hunter Niehus
- Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA
- Portland Veterans Hospital Administration, Portland, OR, USA
| | - Ali Noel Gunesch
- Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - Nina Rodriguez
- Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | - Julianna Khoury
- Dell Medical School at The University of Austin, Austin, TX, USA
| | - Annie Ma
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nina Gu
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Thy Cao
- William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA
| | - Megan Muller
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Christopher Moriates
- Costs of Care, Boston, MA, USA
- VA Greater Los Angeles Healthcare System and UCLA, Los Angeles, CA, USA
| | - Anne S Linker
- Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | - Micah Prochaska
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - David Fish
- University of Massachusetts Chan Medical School Bay State, Northampton, MA, USA
| | - Glenn Moulder
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Melissa Stephens
- William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA
| | - Patricia A Carney
- Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - Andrea Smeraglio
- Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA.
- Portland Veterans Hospital Administration, Portland, OR, USA.
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2
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Baglien BD, Ganesh Kumar N, Berlin NL, Hawley ST, Jagsi R, Momoh AO. Financial Toxicity in Breast Reconstruction: The Role of the Surgeon-Patient Cost-of-Care Discussion. Semin Plast Surg 2024; 38:39-47. [PMID: 38495060 PMCID: PMC10942833 DOI: 10.1055/s-0043-1778040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The financial burden of breast cancer treatment and reconstruction is a significant concern for patients. Patient desire for preoperative cost-of-care counseling while navigating the reconstructive process remains unknown. A cross-sectional survey of women from the Love Research Army was conducted. An electronic survey was distributed to women over 18 years of age and at least 1 year after postmastectomy breast reconstruction. Descriptive statistics and multivariable modeling were used to determine desire for and occurrence of cost-of-care discussions, and factors associated with preference for such discussions. Secondary outcomes included the association of financial toxicity with desire for cost discussions. Among 839 women who responded, 620 women (74.1%) did not speak to their plastic surgeon and 480 (57.4%) did not speak to a staff member regarding costs of breast reconstruction. Of the 550 women who reported it would have been helpful to discuss costs, 315 (57.3%) were not engaged in a financial conversation initiated by a health care provider. A greater proportion of women who reported financial toxicity, compared to those who did not, would have preferred to discuss costs with their plastic surgeon (65.2% vs. 43.5%, p < 0.001) or a staff member (75.5% vs. 59.3%, p < 0.001). Among women with financial toxicity, those who had some form of insurance (private, Medicaid, Medicare, "other") were significantly more likely to prefer a cost-of-care discussion ( p < 0.001, p = 0.02, p = 0.05, p = 0.01). Financial discussions about the potential costs of breast reconstruction seldom occurred in this national cohort. Given the reported preference and unmet need for financial discussions by a majority of women, better cost transparency and communication is needed.
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Affiliation(s)
- Brigit D. Baglien
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Nishant Ganesh Kumar
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Nicholas L. Berlin
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sarah T. Hawley
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Adeyiza O. Momoh
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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3
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Desai V, Cottrell J, Sowerby L. No longer a blank cheque: a narrative scoping review of physician awareness of cost. Public Health 2023; 223:15-23. [PMID: 37595425 DOI: 10.1016/j.puhe.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES Healthcare costs have been steadily rising, and attention to cost containment in healthcare systems is increasingly important. It has been previously established that physicians lack adequate awareness of cost in health care and that by increasing awareness, costs can be reduced. This scoping review examines cost awareness of medications, investigations and procedures and identifies potential interventions that may serve to improve physician awareness. STUDY DESIGN A scoping review was performed to evaluate the literature based on established Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS A review of electronic databases was performed for studies regarding physician awareness of cost, including PubMed, Embase, Cochrane Central Register of Controlled Trials and Google Scholar. RESULTS An initial 4350 citations were identified, and 76 articles were included for full text analysis. Combined, these studies assessed 18,901 physicians. The overwhelming majority (91%) found cost awareness in physicians was low and demonstrated significant room for cost reduction. Eighteen of the 76 studies assessed an intervention to improve physician awareness of cost and used either a price list (89%) or a teaching session (11%) as the primary intervention. CONCLUSIONS Research demonstrates that there is still a lack of awareness among physicians of the costs of medications, investigations and procedures/consumables. Initial approaches using price display and teaching sessions have shown promise. Further research into best practices for education around cost, beginning in medical school and continuing into established medical and surgical practices, may lead to increased cost savings in health care.
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Affiliation(s)
- V Desai
- School of Medicine, Queen's University, Kingston, ON, Canada.
| | - J Cottrell
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - L Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
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4
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Saeki S, Iwatani T, Kitano A, Sakurai N, Tanabe Y, Yamauchi C, Igarashi A, Kajimoto Y, Kuba S, Hara F, Sagara Y, Ohno S. Factors associated with financial toxicity in patients with breast cancer in Japan: a comparison of patient and physician perspectives. Breast Cancer 2023; 30:820-830. [PMID: 37310584 PMCID: PMC10404186 DOI: 10.1007/s12282-023-01476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Financial toxicity (FT) is a notable concern for patients with breast cancer worldwide. The situation regarding FT in Japan, however, has not been well explored. This study examined FT in patients with breast cancer in Japan and presented an overview of the group study's overall findings. METHODS The survey used the Questant application and primarily targeted patients with breast cancer attending research facilities and physicians who are members of the Japanese Breast Cancer Society. The Japanese version of the Comprehensive Score for FT (COST) was used to quantify patients' FT. Multiple regression analysis was used to identify factors related to FT in patients with breast cancer in Japan and evaluate the sufficiency of information support level (ISL) for medical expenses. RESULTS We collected 1558 responses from patients and 825 from physicians. In terms of factors affecting FT, recent payments had the highest impact, followed by stage, and related departments positively affecting FT. Conversely, factors such as income, age, and family support were found to negatively affect FT. A significant discrepancy was identified between patients and physicians in perceived information support, with patients frequently feeling unsupported and physicians believing that they have provided adequate support. Furthermore, differences in the frequency of explanations and opportunities to ask questions about medical costs across FT grades were found. The analysis also showed that physicians with a better understanding of information support needs and greater knowledge of medical costs tended to provide more support that is comprehensive. CONCLUSION This study emphasizes the importance of addressing FT in patients with breast cancer in Japan and highlights the need for enhanced information support, deeper understanding by physicians, and collaborative efforts among professionals to mitigate financial burden and provide personalized, tailored support for individual needs.
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Affiliation(s)
- Sumito Saeki
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
- Graduate School of Medicine, Department of Cancer Therapy and Surgery, Tohoku University, Sendai, Japan.
| | - Tsuguo Iwatani
- Department of Breast Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Atsuko Kitano
- Department of Medical Oncology, St Luke's International Hospital, Tokyo, Japan
| | | | - Yuko Tanabe
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Chikako Yamauchi
- Radiation Therapy Center, Shiga General Hospital, Moriyama, Japan
| | - Ataru Igarashi
- Department of Pharmaceutical Policy, The University of Tokyo, Tokyo, Japan
| | - Yusuke Kajimoto
- Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
- Oncology Science Unit, MSD K.K, Tokyo, Japan
| | - Sayaka Kuba
- Graduate School of Biomedical Sciences, Department of Surgery, Nagasaki University, Nagasaki, Japan
| | - Fumikata Hara
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yasuaki Sagara
- Department of Breast and Thyroid Surgical Oncology, Hakuaikai Sagara Hospital, Kagoshima, Japan
| | - Shinji Ohno
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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5
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Gellings JA, Cortina CS, Jorns JM, Johnson MK, Huang CC, Kong AL. Annual cost-savings with the implementation of estrogen-receptor-only testing on Ductal Carcinoma in Situ specimens. Am J Surg 2023; 225:304-308. [PMID: 36283883 DOI: 10.1016/j.amjsurg.2022.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/08/2022] [Accepted: 09/29/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND In DCIS, ER status is an important marker. The utility of concomitant PR testing remains unclear. METHODS A single-institution retrospective cohort study was performed with a comparative analysis of the NCDB to assess annual cost-savings with omission of routine PR testing. National Medicare payment standards determined PR staining costs to be $124.92. RESULTS 150 institutional DCIS cases with receptor data were identified. 104 (69%) were ER+/PR+, 16 (11%) were ER+/PR-, and none were ER-/PR+. Omission of routine PR testing would have resulted in $18,738 saved annually. Within the NCDB, 34,100 DCIS cases had receptor data: 29,277 (85.9%) patients were ER+, and 26,008 (76%) were both ER/PR+. 211 (0.6%) patients were ER-/PR+. Annual national cost-savings with omission of routine PR-testing would have been $4.3 million. CONCLUSION PR testing for DCIS should be reserved only for patients with ER- DCIS undergoing breast conservation to determine the utility of adjuvant endocrine therapy.
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Affiliation(s)
- Jaclyn A Gellings
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA; Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA.
| | - Julie M Jorns
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Morgan K Johnson
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chiang-Ching Huang
- Joseph J. Zilber School of Public Health, University of Wisconsin, 1240 N 10th St., Milwaukee, WI, 53205, USA.
| | - Amanda L Kong
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA; Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA.
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6
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Gordon LG, Nabukalu D, Chan RJ, Goldsbury DE, Hobbs K, Hunt L, Karikios DJ, Mackay G, Muir L, Leigh L, Thamm C, Lindsay D, Whittaker K, Varlow M, McLoone J, Financial Toxicity Working Group OBOTC. Opinions and strategies of Australian health professionals on tackling cancer-related financial toxicity: A nationwide survey. Asia Pac J Clin Oncol 2023; 19:126-135. [PMID: 35589922 DOI: 10.1111/ajco.13786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/20/2023]
Abstract
AIM To understand the opinions and current practices of health professionals on the topic of addressing cancer-related financial toxicity among patients. METHODS A cross-sectional online survey was distributed through Australian clinical oncology professional organizations/networks. The multidisciplinary Clinical Oncology Society of Australia Financial Toxicity Working Group developed 25 questions relating to the frequency and comfort levels of patient-clinician discussions, opinions about their role, strategies used, and barriers to providing solutions for patients. Descriptive statistics were used and subgroup analyses were undertaken by occupational groups. RESULTS Two hundred and seventy-seven health professionals completed the survey. The majority were female (n = 213, 77%), worked in public facilities (200, 72%), and treated patients with varied cancer types across all of Australia. Most participants agreed that it was appropriate in their clinical role to discuss financial concerns and 231 (88%) believed that these discussions were an important part of high-quality care. However, 73 (28%) stated that they did not have the appropriate information on support services or resources to facilitate such conversations, differing by occupation group; 7 (11%) social workers, 34 (44%) medical specialists, 18 (25%) nurses, and 14 (27%) of other occupations. Hindrances to discussing financial concerns were insufficient resources or support systems to refer to, followed by lack of time in a typical consultation. CONCLUSION Health professionals in cancer care commonly address the financial concerns of their patients but attitudes differed across occupations about their role, and frustrations were raised about available solutions. Resources supporting financial-related discussions for all health professionals are urgently needed to advance action in this field.
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Affiliation(s)
- Louisa G Gordon
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia.,Queensland University of Technology (QUT), School of Nursing and Cancer and Palliative Care Outcomes Centre, Brisbane, Kelvin Grove, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Herston, Australia
| | - Doreen Nabukalu
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - David E Goldsbury
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Kim Hobbs
- Oncology Social Work Australia & New Zealand/Westmead Hospital NSW, Westmead, New South Wales, Australia
| | - Lee Hunt
- Cancer Voices NSW, Sydney NSW, Australia
| | - Deme J Karikios
- Department of Medical Oncology, Nepean Hospital, Kingswood, New South Wales, Australia.,Nepean Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gillian Mackay
- Clinical Oncology Society of Australia, Sydney, New South Wales, Australia
| | - Laura Muir
- Cancer Council NSW, Sydney, New South Wales, Australia
| | | | - Carla Thamm
- Queensland University of Technology (QUT), School of Nursing and Cancer and Palliative Care Outcomes Centre, Brisbane, Kelvin Grove, Australia
| | - Daniel Lindsay
- Faculty of Medicine, University of Queensland, Brisbane, Herston, Australia
| | | | | | - Jordana McLoone
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital NSW, Sydney, New South Wales, Australia.,Discipline of Paediatrics & Child Health, UNSW Medicine & Health, Randwick Clinical Campus, University of NSW, Sydney, New South Wales, Australia
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7
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Agarwal A, Karikios DJ, Stockler MR, Morton RL. Discussion of costs and financial burden in clinical practice: A survey of medical oncologists in Australia. PLoS One 2022; 17:e0273620. [PMID: 36269711 PMCID: PMC9586404 DOI: 10.1371/journal.pone.0273620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/12/2022] [Indexed: 11/07/2022] Open
Abstract
Background A diagnosis of cancer is associated with significant physical, psychological and financial burden. Including costs of cancer is an important component of shared decision making. Doctors bear a responsibility towards educating patients about the financial aspects of care. Multiple organisations have advocated for price transparency and implementing Informed Financial Consent in the clinic. However, few studies have evaluated the perspectives of oncologists on the current state of this discussion. Aims The aim of this study is to determine the views and perspectives of medical oncologists regarding communication of costs and financial burden in patients with cancer. Methods We conducted a prospective cross-sectional online survey via REDCap. The survey was distributed to medical oncologists and advanced trainees currently registered with Medical Oncology Group of Australia (MOGA). Data was collected using the online survey comprising socio-demographic characteristics, discussion of costs and financial burden, and facilitators and barriers to these discussions. Results 547 members of MOGA were invited to participate in the study, and 106 of 547 MOGA members (19%) completed the survey. Most oncologists (66%) felt that it was their responsibility to discuss costs of care, however a majority of oncologists (59.3%) reported discussing costs with less than half of their patients. Only 25% of oncologists discussed financial concerns with more than half of their patients, and most oncologists were unfamiliar with cancer-related financial burden. Most Oncologists with greater clinical experience and those working in private practice were more likely to discuss costs with a majority of their patients. Conclusions Certain characteristics of medical oncologists and their practices were associated with reported prevalence of discussing costs of care and financial burden with their patients. In the context of rising costs of cancer care, interventions targeting modifiable factors such as raising oncologist awareness of costs of care and financial burden, screening for financial toxicity and availability of costs information in an easily accessible manner, may help increase the frequency of patient-doctor discussions about costs of care, contributing to informed decision-making and higher-quality cancer care.
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Affiliation(s)
- Anupriya Agarwal
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
- * E-mail:
| | - Deme J. Karikios
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
- Nepean Cancer Centre, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Martin R. Stockler
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Chris O’Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Rachael L. Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
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8
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Berlin NL, Abrahamse P, Momoh AO, Katz SJ, Jagsi R, Hamilton AS, Ward KC, Hawley ST. Perceived financial decline related to breast reconstruction following mastectomy in a diverse population-based cohort. Cancer 2022; 128:1284-1293. [PMID: 34847259 PMCID: PMC8882150 DOI: 10.1002/cncr.34048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/19/2021] [Accepted: 11/12/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite mandated insurance coverage for breast reconstruction following mastectomy, health care costs are increasingly passed on to women through cost-sharing arrangements and high-deductible health plans. In this population-based study, the authors assessed perceived financial and employment declines related to breast reconstruction following mastectomy. METHODS Women with early-stage breast cancer (stages 0-II) diagnosed between July 2013 and May 2015 who underwent mastectomy were identified through the Surveillance, Epidemiology, and End Results registries of Georgia and Los Angeles and were surveyed. Primary outcome measures included patients' appraisal of their financial and employment status after cancer treatment. Multivariable models evaluated the association between breast reconstruction and primary outcomes. RESULTS Among 883 patients with breast cancer who underwent mastectomy, 44.2% did not undergo breast reconstruction, and 55.8% underwent reconstruction. Overall, 21.9% of the cohort reported being worse off financially since their diagnosis (25.8% with reconstruction vs 16.6% without reconstruction; P = .002). Women who underwent reconstruction reported higher out-of-pocket medical expenses (32.1% vs 15.6% with expenses greater than $5000; P < .001). Reconstruction was independently associated with a perceived decline in financial status (odds ratio, 1.92; 95% confidence interval, 1.15-3.22; P = .013). Among women who were employed at the time of their diagnosis, there was no association between reconstruction and a perceived decline in employment status (P = .927). CONCLUSIONS In this diverse cohort of women who underwent mastectomy, those who elected to undergo reconstruction experienced higher out-of-pocket medical expenses and self-reported financial decline. Patients, providers, and policymakers should be aware of the potential financial implications related to reconstruction despite mandatory insurance coverage.
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Affiliation(s)
- Nicholas L Berlin
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan.,National Clinician Scholars Program, Institute for Health Policy and Innovation, Ann Arbor, Michigan
| | - Paul Abrahamse
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Adeyiza O Momoh
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Steven J Katz
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sarah T Hawley
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.,Health Care Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Patel MR, Jagsi R, Resnicow K, Smith SN, Hamel LM, Su C, Griggs JJ, Buchanan D, Isaacson N, Torby M. A Scoping Review of Behavioral Interventions Addressing Medical Financial Hardship. Popul Health Manag 2021; 24:710-721. [PMID: 33989065 PMCID: PMC8713277 DOI: 10.1089/pop.2021.0043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Little information has been compiled across studies about existing interventions to mitigate issues of medical financial hardship, despite growing interest in health care delivery. The purpose of this qualitative systematic scoping review was to examine content and outcomes of interventions to address medical financial hardship. PRISMA guidelines were applied to present results using PubMed, Scopus, and CINAHL, published between January 1980 and August 2020. Additional studies were identified through reference lists of selected papers. Included studies focused on mitigating medical financial hardship from out-of-pocket (OOP) health care expenses as an intervention strategy with at least 1 evaluation component. Screening 2412 articles identified 339 articles for full-text review, 12 of which met inclusion criteria. Variation was found regarding targets and outcome measurement of intervention. Primary outcomes were in the following categories: financial outcomes (eg, OOP expenses), behavioral outcomes, psychosocial, health care utilization, and health status. No included studies reported significant reduction in OOP expenses, perceptions of financial burden/toxicity, or health status. However, changes were observed for behavioral outcomes (adherence to treatment, patient needs addressed), some psychosocial outcomes (mental health symptoms, perceived support, patient satisfaction), and care utilization such as routine health care. No patterns were observed in the achievement of outcomes across studies based on intensity of intervention. Few rigorous studies exist in this emerging field, and studies have not shown consistent positive effects. Future research should focus on conceptual clarity of the intervention, align outcome measurement and achieve consensus around outcomes, and employ rigorous study designs, measurement, and outcome follow-up.
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Affiliation(s)
- Minal R. Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Reshma Jagsi
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, Michigan, USA
- Center for Bioethics and Social Sciences Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Shawna N. Smith
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Lauren M. Hamel
- Wayne State University School of Medicine/Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Christopher Su
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Internal Medicine-Hematology and Oncology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jennifer J. Griggs
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Department of Internal Medicine-Hematology and Oncology, Michigan Medicine, Ann Arbor, Michigan, USA
- Michigan Oncology Quality Consortium, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Diamond Buchanan
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Nicole Isaacson
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Michelle Torby
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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10
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Ganesh Kumar N, Berlin NL, Hawley ST, Jagsi R, Momoh AO. Financial Toxicity in Breast Reconstruction: A National Survey of Women Who have Undergone Breast Reconstruction After Mastectomy. Ann Surg Oncol 2021; 29:535-544. [PMID: 34480284 DOI: 10.1245/s10434-021-10708-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/29/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite awareness regarding financial toxicity in breast cancer care, little is known about the financial strain associated with breast reconstruction. This study aims to describe financial toxicity and identify factors independently associated with financial toxicity for women pursuing post-mastectomy breast reconstruction. METHODS A 33-item electronic survey was distributed to members of the Love Research Army. Women over 18 years of age and at least 1 year after post-mastectomy breast reconstruction were invited to participate. The primary outcome of interest was self-reported financial toxicity due to breast reconstruction, while secondary outcomes of interest were patient-reported out-of-pocket expenses and impact of financial toxicity on surgical decision making. RESULTS In total, 922 women were included (mean age 58.6 years, standard deviation 10.3 years); 216 women (23.8%) reported financial toxicity from reconstruction. These women had significantly greater out-of-pocket medical expenses. When compared with women who did not experience financial toxicity, those who did were more likely to have debt due to reconstruction (50.9% vs. 3.2%, p < 0.001). Younger age, lower annual household income, greater out-of-pocket expenses, and a postoperative major complication were independently associated with an increased risk for financial toxicity. If faced with the same decision, women experiencing financial toxicity were more likely to decide against reconstruction (p < 0.001) compared with women not experiencing financial toxicity. CONCLUSIONS Nearly one in four women experienced financial toxicity from breast reconstruction. Women who reported higher levels of financial toxicity were more likely to change their decisions about surgery. Identified factors predictive of financial toxicity could guide preoperative discussions to inform decision making that mitigates undesired financial decline.
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Affiliation(s)
- Nishant Ganesh Kumar
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas L Berlin
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.,National Clinician Scholars Program, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Sarah T Hawley
- Department of Internal Medicine and Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor, USA
| | - Adeyiza O Momoh
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.
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11
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Shivakumar V, Bundorf MK, Vezeridis AM, Kothary N. The Role of Physician-Driven Device Preference in the Cost Variation of Common Interventional Radiology Procedures. J Vasc Interv Radiol 2021; 32:672-676. [PMID: 33781687 DOI: 10.1016/j.jvir.2021.01.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/22/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To analyze the impact of physician-specific equipment preference on cost variation for procedures typically performed by interventional radiologists at a tertiary care academic hospital. MATERIALS AND METHODS From October 2017 to October 2019, data on all expendable items used by 9 interventional radiologists for 11 common interventional radiology procedure categories were compiled from the hospital analytics system. This search yielded a final dataset of 44,654 items used in 2,121 procedures of 11 different categories. The mean cost per case for each physician as well as the mean, standard deviation, and coefficient of variation (CV) of the mean cost per case across physicians were calculated. The proportion of spending by item type was compared across physicians for 2 high-variation, high-volume procedures. The relationship between the mean cost per case and case volume was examined using linear regression. RESULTS There was a high variability within each procedure, with the highest and the lowest CV for radioembolization administration (56.6%) and transjugular liver biopsy (4.9%), respectively. Variation in transarterial chemoembolization cost was mainly driven by microcatheters/microwires, while for nephrostomy, the main drivers were catheters/wires and access sets. Mean spending by physician was not significantly correlated with case volume (P =.584). CONCLUSIONS Physicians vary in their item selection even for standard procedures. While the financial impact of these differences vary across procedures, these findings suggest that standardization may offer an opportunity for cost savings.
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Affiliation(s)
- Vinita Shivakumar
- Stanford University School of Medicine, Stanford, California, United States
| | - M Kate Bundorf
- Duke University Sanford School of Health Policy, Durham, North Carolina, United States
| | - Alexander M Vezeridis
- Department of Interventional Radiology, Stanford University School of Medicine, Stanford, California, United States
| | - Nishita Kothary
- Department of Interventional Radiology, Stanford University School of Medicine, Stanford, California, United States.
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12
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Sheckter CC, Aliu O, Bailey C, Liu J, Selber JC, Butler CE, Offodile Ii AC. Exploring provider- and practice-level drivers of cost-consciousness in breast cancer reconstruction-secondary analysis of a survey of the American Society of Plastic Surgeons. Breast Cancer Res Treat 2021; 187:569-576. [PMID: 33464457 DOI: 10.1007/s10549-020-06085-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The role of physicians in dampening health care costs is a renewed focus of policy-makers. We examined provider- and practice-level factors affecting four domains of cost-consciousness among plastic surgeons performing breast reconstruction. METHODS Secondary analysis was performed on the survey responses of 329 surgeons who routinely performed breast reconstruction. Using a 5-point Likert scale, we queried four domains of cost-consciousness: out-of-pocket cost awareness, cost discussions, cognizance of patients' financial burden, and attitudes regarding cost discussions. Multivariable linear regression was performed to identify provider- and practice-level factors affecting these domains according to composite scores. RESULTS Overall cost-consciousness scores (CS) were moderate and ranged from 2.14 to 4.30. There were no significant differences across practice settings. Male gender (p = 0.048), Hispanic ethnicity (p = 0.021), and increasing clinical experience (p = 0.015) were associated with higher out-of-pocket cost awareness. Increasing surgeon experience was also associated with having cost discussions (p = 0.039). No provider- or practice-level factors were associated with cognizance of patients' financial burden. Salaried physicians displayed a more positive attitude toward out-of-pocket cost discussions (p = 0.049). On pairwise testing, the out-of-pocket cost awareness was significantly different between Hispanic surgeons and white surgeons (4.30 vs. 3.55), and between surgeons with more than 20 years' experience and with less than 5 years' experience (3.87 vs. 3.37). CONCLUSIONS Surgeon gender, ethnicity, and experience and practice compensation type inform various domains of cost-consciousness in breast reconstruction. Structural and behavioral interventions could possibly increase physicians' cost-consciousness.
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Affiliation(s)
- Clifford C Sheckter
- Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
| | - Oluseyi Aliu
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Jun Liu
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Unit 1488, 1400 Pressler St., Houston, TX, 77030, USA
| | - Jesse C Selber
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Unit 1488, 1400 Pressler St., Houston, TX, 77030, USA
| | - Charles E Butler
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Unit 1488, 1400 Pressler St., Houston, TX, 77030, USA
| | - Anaeze C Offodile Ii
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Unit 1488, 1400 Pressler St., Houston, TX, 77030, USA. .,Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Baker Institute for Public Policy, Rice University, Houston, TX, USA.
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13
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Matsumoto HH, Ogiya R, Matsuda S. Association between variations in the number of hospital beds and inpatient chemo/radiotherapy for breast cancer: a study using a large claim database. Acta Oncol 2020; 59:1072-1078. [PMID: 32657192 DOI: 10.1080/0284186x.2020.1787506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Chemo/radiotherapy for breast cancer patients does not require hospitalisation in most cases. We investigated the relationship between the proportion of hospitalisation for chemo/radiotherapy over total hospitalisation and the number of hospital beds per capita among breast cancer cases. DESIGN A retrospective observational study. SETTING Hospitals in Japan. PARTICIPANTS In total, 561,165 records of hospitalisation of breast cancer cases were extracted from the Japanese Diagnosis Procedure Combination database from April 2012 to March 2016.Intervention(s) and main outcome measure(s): A multivariable beta regression model accounting for the clustering effect within each prefecture was used to examine the relationship between the number of hospital beds per capita in each prefecture and the proportion of hospitalisation for inpatient chemo/radiotherapy treatment or the number of surgical operations for breast cancer patients in each prefecture. RESULTS The proportion of hospitalisation for inpatient chemo/radiotherapy treatment varied from 2.6% to 61.8% in 2016. The logit proportion of hospitalisation for inpatient chemo/radiotherapy treatment was significantly higher for every additional hospital bed per capita (0.0027, 95% confidence interval (95% CI) 0.0014-0.0040). In contrast, no significant relationship was observed between the number of surgical operations for breast cancer per capita and the number of hospital beds per capita. CONCLUSIONS We found that a higher number of regional hospital beds were associated with a higher proportion of hospitalisation for chemo/radiotherapy treatment, suggesting that inpatient chemo/radiotherapy may be a provider-induced practice.
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Affiliation(s)
- Haruki Harry Matsumoto
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Rin Ogiya
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
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14
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Bailey CM, Selber J, Liu J, Lee CN, Offodile AC. Current Practice and Perceptions Regarding Cost Communication in Breast Cancer Reconstruction: Survey Results of the American Society of Plastic Surgeons. Ann Surg Oncol 2020; 28:376-385. [PMID: 32613364 DOI: 10.1245/s10434-020-08750-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Rising out-of-pocket costs (OOCs) are a major concern for breast cancer survivors. However, information on how plastic surgeons performing breast reconstruction (BR) perceive and communicate cost information is limited. METHODS An electronic, anonymous survey eliciting plastic surgeons' attitudes and behaviors regarding BR cost communication was distributed to active American Society of Plastic Surgery members. Questions were derived from previously published studies and entailed a 5-point Likert scale. Cost communication was identified based on dichotomized responses to the prompt, "I discuss the costs of breast reconstruction with my patients," and analyzed for associated factors. RESULTS Of the 5112 surgeons surveyed, 396 plastic surgeons responded (7.21%). Most of the surgeons reported having a sense of a patient's financial well-being (65%) and an awareness of treatment costs (66.9%). Most felt a responsibility to consider the impact of BR costs (69%). Although most of the surgeons expressed that they were comfortable having OOC discussions (58.9%), only a minority reported doing so routinely (24.2%). The fewest respondents (8.6%) cited OOC as an important variable for BR decision-making. Lack of supportive tools was the most cited barrier to having cost communication with patients (64.8%). Cost communication was identified in a minority (20.2%) of surgeon-patient encounters and had no significant relationship to surgeon demographics or practice setting. CONCLUSIONS Plastic surgeons rarely discuss costs of BR with patients despite having a high awareness of the topic and feeling comfortable with it. Prevailing attitudes about the importance of OOC and the lack of administrative support or cost information are likely the drivers of this mismatch and warrant further study.
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Affiliation(s)
- Chad M Bailey
- Plastic and Reconstructive Surgeons, Renton, WA, USA
| | - Jesse Selber
- Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jun Liu
- Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clara N Lee
- Department of Plastic Surgery, The Ohio State University, Columbus, OH, USA
| | - Anaeze C Offodile
- Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Baker Institute for Public Policy, Rice University, Houston, TX, USA.
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15
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Veenstra CM, Hawley ST. Incorporating patient preferences into cancer care decisions: Challenges and opportunities. Cancer 2020; 126:3393-3396. [DOI: 10.1002/cncr.32959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/09/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Christine M. Veenstra
- Division of Hematology/Oncology Department of Internal Medicine University of Michigan Ann Arbor Michigan USA
| | - Sarah T. Hawley
- Division of General Medicine Department of Internal Medicine University of Michigan, Ann Arbor Veterans Affairs Center for Clinical Management Research Ann Arbor Michigan USA
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16
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Bai G, Bai Y. Voluntary or Forced: Different Effects of Personal and Social Norms on Urban Residents' Environmental Protection Behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103525. [PMID: 32443495 PMCID: PMC7277839 DOI: 10.3390/ijerph17103525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/07/2020] [Accepted: 05/15/2020] [Indexed: 11/16/2022]
Abstract
It is well known that environmental protection behaviors are influenced by both individual internal motivation and external environmental pressure, but few studies have looked at the two kinds of factors together. In order to study the influence mechanism of these two kinds of factors on the environmental protection behavior of urban residents, especially the difference between these two kinds of factors, we take personal norms and social norms as independent variables into the theoretical model. Results based on survey data of 731 urban residents revealed that personal norms and social norms both are positively associated with environmental protection behavior. Moreover, environmental protection willingness was found to mediate the relationship of personal and social norms with environmental protection behavior. We also found that the direct and indirect influences of personal norms on environmental protection behavior are greater than that of social norms. Further, the study revealed that cost consciousness moderates the relationship between personal norms, environmental protection willingness, and environmental protection behavior. Our results suggest that personal norms have a greater impact on environmental protection behavior than social norms. Therefore, we need to make greater efforts to promote environmental education and cultivate young people's sense of environmental responsibility from an early age. At the same time, it is necessary to maintain appropriate environmental pressure and reduce the environmental cost in the daily life of residents.
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17
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Yabroff KR, Zhao J, de Moor JS, Sineshaw HM, Freedman AN, Zheng Z, Han X, Rai A, Klabunde CN. Factors Associated With Oncologist Discussions of the Costs of Genomic Testing and Related Treatments. J Natl Cancer Inst 2020; 112:498-506. [PMID: 31675070 PMCID: PMC7225678 DOI: 10.1093/jnci/djz173] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/31/2019] [Accepted: 09/04/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Use of genomic testing is increasing in the United States. Testing can be expensive, and not all tests and related treatments are covered by health insurance. Little is known about how often oncologists discuss costs of testing and treatment or about the factors associated with those discussions. METHODS We identified 1220 oncologists who reported discussing genomic testing with their cancer patients from the 2017 National Survey of Precision Medicine in Cancer Treatment. Multivariable polytomous logistic regression analyses were used to assess associations between oncologist and practice characteristics and the frequency of cost discussions. All statistical tests were two-sided. RESULTS Among oncologists who discussed genomic testing with patients, 50.0% reported often discussing the likely costs of testing and related treatments, 26.3% reported sometimes discussing costs, and 23.7% reported never or rarely discussing costs. In adjusted analyses, oncologists with training in genomic testing or working in practices with electronic medical record alerts for genomic tests were more likely to have cost discussions sometimes (odds ratio [OR] = 2.09, 95% confidence interval [CI] = 1.19 to 3.69) or often (OR = 2.22, 95% CI = 1.30 to 3.79), respectively, compared to rarely or never. Other factors statistically significantly associated with more frequent cost discussions included treating solid tumors (rather than only hematological cancers), using next-generation sequencing gene panel tests, having higher patient volume, and working in practices with higher percentages of patients insured by Medicaid, or self-paid or uninsured. CONCLUSIONS Interventions targeting modifiable oncologist and practice factors, such as training in genomic testing and use of electronic medical record alerts, may help improve cost discussions about genomic testing and related treatments.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Jingxuan Zhao
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | | | - Helmneh M Sineshaw
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | | | - Zhiyuan Zheng
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Ashish Rai
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Carrie N Klabunde
- National Cancer Institute, and Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD
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18
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Maghbouli N, Akbari Sari A, Asghari F. Cost-consciousness among Iranian internal medicine residents. MEDICAL TEACHER 2020; 42:463-468. [PMID: 32009508 DOI: 10.1080/0142159x.2019.1708292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Study aimed at assessing residents' cost awareness and their attitude about health care costs.Methods: Internal medicine residents at teaching hospitals of Tehran University of Medical Sciences were surveyed during August-December 2016 using a researcher-made questionnaire comprising attitude statements and cost estimation of diagnostic and treatment items.Results: Eighty-nine residents completed the survey (response rate = 56.6%). The results indicate that less than one quarter (23.69%) of cost estimates were in the range of correct answers. The mean (SD) for correct estimation of medications (out of 8 scores), lab tests (out of 20 scores), and total (out of 35 scores) were 1.25 (0.96), 4.92 (0.27), and 7.97 (0.34), respectively. An analysis of variance showed that the level of residency was positively correlated with residents' correct cost estimation (F (3, 77)=9.98, p = 0.029). There was a significant positive correlation between age of residents with the correct estimate of medication prices (p = 0.018, r = 0.261).Conclusions: The internal medicine residents of Tehran University of Medical Sciences have poor knowledge of health care costs, including medications, diagnostic tests, and hospitalization costs. The results of this study explain the necessity of developing a training program for the transfer of cost information to physicians.
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Affiliation(s)
- Nastaran Maghbouli
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Asghari
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
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19
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Boyce-Fappiano D, Ning MS, Thaker NG, Pezzi TA, Gjyshi O, Mesko S, Anakwenze C, Olivieri ND, Guzman AB, Incalcaterra JR, Tang C, McAleer MF, Herman J, Ghia AJ. Time-Driven, Activity-Based Cost Analysis of Radiation Treatment Options for Spinal Metastases. JCO Oncol Pract 2020; 16:e271-e279. [DOI: 10.1200/jop.19.00480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Several treatment options for spinal metastases exist, including multiple radiation therapy (RT) techniques: three-dimensional (3D) conventional RT (3D-RT), intensity-modulated RT (IMRT), and spine stereotactic radiosurgery (SSRS). Although data exist regarding reimbursement differences across regimens, differences in provider care delivery costs have yet to be evaluated. We quantified institutional costs associated with RT for spinal metastases, using a time-driven activity-based costing model. METHODS: Comparisons were made between (1) 10-fraction 3D-RT to 30 Gy, (2) 10-fraction IMRT to 30 Gy, (3) 3-fraction SSRS (SSRS-3) to 27 Gy, and (4) single-fraction SSRS (SSRS-1) to 18 Gy. Process maps were developed from consultation through follow-up 30 days post-treatment. Process times were determined through panel interviews, and personnel costs were extracted from institutional salary data. The capacity cost rate was determined for each resource, then multiplied by activity time to calculate costs, which were summed to determine total cost. RESULTS: Full-cycle costs of SSRS-1 were 17% lower and 17% higher compared with IMRT and 3D-RT, respectively. Full-cycle costs for SSRS-3 were only 1% greater than 10-fraction IMRT. Technical costs for IMRT were 50% and 77% more than SSRS-3 and SSRS-1. In contrast, personnel costs were 3% and 28% higher for SSRS-1 than IMRT and 3D-RT, respectively ( P < .001). CONCLUSIONS: Resource utilization varies significantly among treatment options. By quantifying provider care delivery costs, this analysis supports the institutional resource efficiency of SSRS-1. Incorporating clinical outcomes with such resource and cost data will provide additional insight into the highest value modalities and may inform alternative payment models, operational workflows, and institutional resource allocation.
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Affiliation(s)
| | - Matthew S. Ning
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Todd A. Pezzi
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Olsi Gjyshi
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shane Mesko
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Chad Tang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mary F. McAleer
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph Herman
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amol J. Ghia
- The University of Texas MD Anderson Cancer Center, Houston, TX
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20
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Xu F, Jiang Z. Prophylaxis of breast cancer chemotherapy for bone marrow toxicity: more individualized and safer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:138. [PMID: 32176221 PMCID: PMC7048996 DOI: 10.21037/atm.2019.12.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 03/29/2024]
Affiliation(s)
- Fengrui Xu
- Department of Breast Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, China
| | - Zefei Jiang
- Department of Breast Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, China
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21
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Implementing routine communication about costs of cancer treatment: perspectives of providers, patients, and caregivers. Support Care Cancer 2020; 28:4255-4262. [PMID: 31900612 DOI: 10.1007/s00520-019-05274-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Rising costs in oncology care often impact patients and families directly, making communication about costs and financial impacts of treatment crucial. Cost expenditures could offer opportunities for estimation and prediction, affording personalized conversations about financial impact. We sought to explore providers', patients', and caregivers' preferences towards implementing communication about cost, including when, how, and by whom such information might be provided. METHODS We conducted semi-structured phone interviews with a diverse population including 12 oncology providers, 12 patients, and 8 patient caregivers (N = 32). The constant comparative method was used to identify mutually agreed upon themes. RESULTS Participant groups differed in their concerns surrounding cost communication, namely whether they want to receive this information and how such information might impact provider and patient treatment decisions. All participants agreed that oncology providers should not be leading cost conversations. Patients and caregivers identified social workers or financial advisors as most equipped to communicate about cost. Participants emphasized timely cost conversations, ideally around the time of diagnosis. Participants favored various metrics of financial impact beyond overall costs of care including disability, days lost from work, and out-of-pocket expenses. CONCLUSION Cost transparency should be incorporated into usual care; however, there are several challenges to making cost conversations a part of everyday practice. Patients and family members need resources related to cost to aid in decision-making and those delivering cost information should have competency in oncology, financial advisement, and patient-centered care.
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22
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Odahowski CL, Zahnd WE, Zgodic A, Edward JS, Hill LN, Davis MM, Perry CK, Shannon J, Wheeler SB, Vanderpool RC, Eberth JM. Financial hardship among rural cancer survivors: An analysis of the Medical Expenditure Panel Survey. Prev Med 2019; 129S:105881. [PMID: 31727380 PMCID: PMC7190004 DOI: 10.1016/j.ypmed.2019.105881] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/19/2019] [Accepted: 10/30/2019] [Indexed: 11/14/2022]
Abstract
Some cancer survivors report spending 20% of their annual income on medical care. Undue financial burden that patients face related to the cost of care is referred to as financial hardship, which may be more prevalent among rural cancer survivors. This study examined contrasts in financial hardship among 1419 rural and urban cancer survivors using the 2011 Medical Expenditure Panel Survey supplement - The Effects of Cancer and Its Treatment on Finances. We combined four questions, creating a measure of material financial hardship, and examined one question on financial worry. We conducted multivariable logistic regression analyses, which produced odds ratios (OR) for factors associated with financial hardship and worry, and then generated average adjusted predicted probabilities. We focused on rural and urban differences classified by metropolitan statistical area (MSA) designation, controlling for age, education, race, marital status, health insurance, family income, and time since last cancer treatment. More rural cancer survivors reported financial hardship than urban survivors (23.9% versus 17.1%). However, our adjusted models revealed no significant impact of survivors' MSA designation on financial hardship or worry. Average adjusted predicted probabilities of financial hardship were 18.6% for urban survivors (Confidence Interval [CI]: 11.9%-27.5%) and 24.2% for rural survivors (CI: 15.0%-36.2%). For financial worry, average adjusted predicted probabilities were 19.9% for urban survivors (CI: 12.0%-31.0%) and 18.8% for rural survivors (CI: 12.1%-28.0%). Improving patient-provider communication through decision aids and/or patient navigators may be helpful to reduce financial hardship and worry regardless of rural-urban status.
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Affiliation(s)
- Cassie L Odahowski
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, United States of America
| | - Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, United States of America; Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, United States of America
| | - Anja Zgodic
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, United States of America
| | - Jean S Edward
- College of Nursing, University of Kentucky, United States of America
| | - Lauren N Hill
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, United States of America
| | - Melinda M Davis
- Oregon Rural Practice-based Research Network, Department of Family Medicine, School of Medicine, Oregon Health & Science University, United States of America; OHSU-PSU School of Public Health, Oregon Health & Sciences University, United States of America
| | - Cynthia K Perry
- School of Nursing, Oregon Health & Sciences University, United States of America
| | - Jackilen Shannon
- OHSU-PSU School of Public Health, Oregon Health & Sciences University, United States of America
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States of America
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, United States of America
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, United States of America.
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