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Kamath CC, Espinoza Suarez NR, Vallejo S, Montori VM, Brito JP, Boehmer KR. Not all cost conversations are the same: An exploration of potential value in cost conversations during Atrial fibrillation treatment decision making. PATIENT EDUCATION AND COUNSELING 2024; 128:108366. [PMID: 39032442 DOI: 10.1016/j.pec.2024.108366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVES To explore the cost conversations taking place when patients with atrial fibrillation and their clinicians decide on whether and how to use anticoagulation to prevent strokes. METHODS Secondary qualitative thematic analysis of conversations from 476 clinical encounters in three sites of a multicenter randomized trial comparing usual care with and without a shared decision-making tool. RESULTS We identified three themes with subthemes: (1) What was discussed: conversation content (2) How content was transmitted: communication patterns and (3) Implicit conversation drivers. Due to each patient's unique circumstances, bi-directional conversations focused on relationship- and solution-based content enabled better cost burden discovery. Conversation drivers included affordability, comorbidities, preferences, and uncertainty about future costs. CONCLUSIONS Cost conversations were often initiated by clinicians, and if they did not invite a response, patients passively received information without understanding or weighing cost burden. When clinicians discussed cost information using relational or solution-focused content and bi-directional communication patients were more likely to engage in discussion including their unique situation. PRACTICE IMPLICATIONS Solution-focused cost conversations can reduce financial treatment burden, but require estimates of out-of-pocket costs, insurance coverage, and long-term financial effects of various options. Conversation tools and information on financial resources are valuable to patients and clinicians.
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Affiliation(s)
- Celia C Kamath
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Nataly R Espinoza Suarez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Center for Sustainable Health Research, Integrated University Health and Social Services Center of Capitale-Nationale, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | | | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
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Mandhana DM, Jacome CS, Ballard DI, Tesfai Y, Johnson SB, Gionfriddo MR, Espinoza Suarez NR, Perneth SA, Su L, Montori VM. Developing and validating the Unhurried Conversations Assessment Tool (UCAT). PATIENT EDUCATION AND COUNSELING 2024; 123:108237. [PMID: 38461793 DOI: 10.1016/j.pec.2024.108237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/29/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Given the importance of unhurried conversations for providing careful and kind care, we sought to create, test, and validate the Unhurried Conversations Assessment Tool (UCAT) for assessing the unhurriedness of patient-clinician consultations. METHODS In the first two phases, the unhurried conversation dimensions were identified and transformed into an assessment tool. In the third phase, two independent raters used UCAT to evaluate the unhurriedness of 100 randomly selected consultations from 184 videos recorded for a large research trial. UCAT's psychometric properties were evaluated using this data. RESULTS UCAT demonstrates content validity based on the literature and expert review. EFA and reliability analyses confirm its construct validity and internal consistency. The seven formative dimensions account for 89.93% of the variance in unhurriedness, each displaying excellent internal consistency (α > 0.90). Inter-rater agreement for the overall assessment item was fair (ICC = 0.59), with individual dimension ICCs ranging from 0.26 (poor) to 0.95 (excellent). CONCLUSION UCAT components comprehensively assess the unhurriedness of consultations. The tool exhibits content and construct validity and can be used reliably. PRACTICE IMPLICATIONS UCAT's design and psychometric properties make it a practical and efficient tool. Clinicians can use it for self-evaluations and training to foster unhurried conversations.
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Affiliation(s)
- Dron M Mandhana
- Department of Communication, Villanova University, Villanova, PA, USA; Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Cristian Soto Jacome
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Norwalk Hospital, Department of Internal Medicine, Nuvance Health, Norwalk, CT, USA
| | - Dawna I Ballard
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Department of Communication Studies, The University of Texas at Austin, Austin, TX, USA
| | - Yohanna Tesfai
- Department of Communication Studies, The University of Texas at Austin, Austin, TX, USA
| | - Sarah B Johnson
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Michael R Gionfriddo
- Division of Pharmaceutical, Administrative, and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA
| | - Nataly R Espinoza Suarez
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Centre for Sustainable Health Research, Integrated University Health and Social Services Center of Capitale-Nationale, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Sandra Algarin Perneth
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Lillian Su
- Division of Cardiovascular Intensive Care Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Victor M Montori
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA.
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Kinzer H, Lee CN, Cooksey K, Myckatyn T, Olsen MA, Foraker R, Johnson AR, Politi MC. Financial Toxicity Considerations in Breast Reconstruction: Recommendations for Research and Practice. Womens Health Issues 2024; 34:107-114. [PMID: 38413293 DOI: 10.1016/j.whi.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/21/2024] [Accepted: 01/31/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Hannah Kinzer
- Washington University in St Louis, School of Medicine, St. Louis, Missouri.
| | - Clara N Lee
- University of North Carolina-Chapel Hill, School of Medicine, Chapel Hill, North Carolina
| | - Krista Cooksey
- Washington University in St Louis, School of Medicine, St. Louis, Missouri
| | - Terence Myckatyn
- Washington University in St Louis, School of Medicine, St. Louis, Missouri
| | - Margaret A Olsen
- Washington University in St Louis, School of Medicine, St. Louis, Missouri
| | - Randi Foraker
- Washington University in St Louis, School of Medicine, St. Louis, Missouri
| | - Anna Rose Johnson
- Washington University in St Louis, School of Medicine, St. Louis, Missouri
| | - Mary C Politi
- Washington University in St Louis, School of Medicine, St. Louis, Missouri
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Hua C, Bhashyam AR, Lubinus M, Wilson L, Bhai S. The personal financial burden associated with idiopathic inflammatory myopathies. Neuromuscul Disord 2023; 33:945-950. [PMID: 38016874 DOI: 10.1016/j.nmd.2023.10.017] [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: 04/24/2023] [Revised: 09/07/2023] [Accepted: 10/27/2023] [Indexed: 11/30/2023]
Abstract
The economic burden of idiopathic inflammatory myopathies (IIMs) within the US is underexplored. We hypothesized that IIMs patients experience considerable personal financial burden due to risks of multi-specialist visits, chronic long-term care, costs associated with disability, medical treatment, and overall high spending costs within the US healthcare system. We surveyed members of Myositis Support and Understanding (MSU) (response rate 4.7 %), and of the 470 survey participants that self-reported with diagnoses of IIMs, we assessed financial burden using two validated measures: (1) Financial Worry Score, and (2) Financial Burden Composite Score (FBCS). We determined factors associated with increased FBCS using logistic and Poisson regression respectively. High financial worry was endorsed by 202 participants (43 %) and the average FBCS ± SD was 1.8 ± 1.9. The odds of financial worry among participants with Medicaid is 3.016 times the odds of financial worry among participants without Medicaid (p = 0.011), and the odds of financial worry among participants with private high-deductible insurance is 3.216 times the odds of financial worry among participants who do not have private high-deductible insurance (p =< 0.001). Given the link between personal financial burden and potential effects on patient outcomes, it is essential for physicians to consider patient financial health when determining management or treatment courses. Identifying specific risk factors that can further exacerbate personal financial burden can help physicians identify vulnerable patients to reduce financial hardship.
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Affiliation(s)
- Catherine Hua
- Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
| | - Abhiram R Bhashyam
- Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA; Myositis Support and Understanding, Lincoln, DE, USA
| | | | - Lynn Wilson
- Myositis Support and Understanding, Lincoln, DE, USA
| | - Salman Bhai
- Myositis Support and Understanding, Lincoln, DE, USA; Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas, TX, USA
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Garcia-Bautista A, Kamath C, Ayala N, Behnken E, Giblon RE, Gravholt D, Hernández-Leal MJ, Hidalgo J, Leon Garcia M, Golembiewski EH, Maraboto A, Sivly A, Brito JP. Financial Toxicity in the Clinical Encounter: A Paired Survey of Patient and Clinician Perceptions. Mayo Clin Proc Innov Qual Outcomes 2023; 7:248-255. [PMID: 37359420 PMCID: PMC10285501 DOI: 10.1016/j.mayocpiqo.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Objective To compare the agreement between patient and clinician perceptions of care-related financial issues. Patients and Methods We surveyed patient-clinician dyads immediately after an outpatient medical encounter between September 2019 and May 2021. They were asked to separately rate (1-10) patient's level of difficulty in paying medical bills and the importance of discussing cost issues with that patient during clinical encounters. We calculated agreement between patient-clinician ratings using the intraclass correlation coefficient and used random effects regression models to identify patient predictors of paired score differences in difficulty and importance of ratings. Results 58 pairs of patients (n=58) and clinicians (n=40) completed the survey. Patient-clinician agreement was poor for both measures, but higher for difficulty in paying medical bills (intraclass correlation coefficient=0.375; 95% CI, 0.13-0.57) than for the importance of discussing cost (-0.051; 95% CI, -0.31 to 0.21). Agreement on difficulty in paying medical bills was not lower in encounters with conversations about the cost of care. In adjusted models, poor patient-clinician agreement on difficulty in paying medical bills was associated with lower patient socioeconomic status and education level, whereas poor agreement on patient-perceived importance of discussing cost was significant for patients who were White, married, reported 1 or more long-term conditions, and had higher education and income levels. Conclusion Even in encounters where cost conversations occurred, there was poor patient-clinician agreement on ratings of the patient's difficulty in paying medical bills and perceived importance of discussing cost issues. Clinicians need more training and support in detecting the level of financial burden and tailoring cost conversations to the needs of individual patients.
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Affiliation(s)
- Andrea Garcia-Bautista
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Celia Kamath
- Robert D and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Nicolas Ayala
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Emma Behnken
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Rachel E Giblon
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Derek Gravholt
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - María José Hernández-Leal
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Pamplona, Spain
- Medical Sciences, Universidad de La Frontera, Temuco, Chile
- Millenium Nucleus of Sociomedicine (Sociomed), Santiago, Chile
| | - Jessica Hidalgo
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Montserrat Leon Garcia
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
- Iberoamerican Cocharane Center, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | | | - Andrea Maraboto
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Angela Sivly
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Juan P Brito
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
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Communication of costs and financial burdens between cancer patients and healthcare providers: a qualitative systematic review and meta-synthesis. Support Care Cancer 2023; 31:192. [PMID: 36847898 DOI: 10.1007/s00520-023-07647-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVES The aim of this study was to synthesize qualitative research regarding communication of costs and financial burdens between patients and healthcare providers to provide evidence for the subsequent development of intervention programs. METHODS Studies published prior to 11 February 2023 were collected from electronic databases, including PubMed/MEDLINE, MEDLINE (Ovid), Web of Science, EMBASE (Ovid), CINAHL (EBSCO), and ProQuest. A checklist for qualitative research drawn from the Joanna Briggs Institute Reviewer's Manual was applied to assess the quality of the included studies. Meta-aggregation was performed to synthesize the findings of the included studies. RESULTS Four synthesized findings were derived from 15 studies: cost communication offered more benefits than drawbacks, and most patients were willing to engage in cost communication; cost communication has been implemented in clinical practice but continued to face shortcomings and barriers; an expected cost communication should take into account timing, location, personnel, personality, and content; healthcare providers required education, information, tools, standardized processes, and policy and organizational support to increase their ability to deliver cost communication. CONCLUSIONS Cost communication can help optimize decision-making and reduce the risk of financial difficulties, as has been widely recognized by patients and healthcare providers. However, a complete clinical practice plan to facilitate cost communication has not yet been created.
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Politi MC, Housten AJ, Forcino RC, Jansen J, Elwyn G. Discussing Cost and Value in Patient Decision Aids and Shared Decision Making: A Call to Action. MDM Policy Pract 2023; 8:23814683221148651. [PMID: 36643615 PMCID: PMC9834940 DOI: 10.1177/23814683221148651] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023] Open
Abstract
Direct and indirect costs of care influence patients' health choices and the ability to implement those choices. Despite the significant impact of care costs on patients' health and daily lives, patient decision aid (PtDA) and shared decision-making (SDM) guidelines almost never mention a discussion of costs of treatment options as part of minimum standards or quality criteria. Given the growing study of the impact of costs in health decisions and the rising costs of care more broadly, in fall 2021 we organized a symposium at the Society for Medical Decision Making's annual meeting. The focus was on the role of cost information in PtDAs and SDM. Panelists gave an overview of work in this space at this virtual meeting, and attendees engaged in rich discussion with the panelists about the state of the problem as well as ideas and challenges in incorporating cost-related issues into routine care. This article summarizes and extends our discussion based on the literature in this area and calls for action. We recommend that PtDA and SDM guidelines routinely include a discussion of direct and indirect care costs and that researchers measure the frequency, quality, and response to this information.
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Affiliation(s)
- Mary C. Politi
- Division of Public Health Sciences, Department
of Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Ashley J. Housten
- Division of Public Health Sciences, Department
of Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Rachel C. Forcino
- The Dartmouth Institute for Health Policy and
Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon,
NH, USA
| | - Jesse Jansen
- School for Public Health and Primary Care
CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and
Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon,
NH, USA
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