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Conversations About Financial Issues in Routine Oncology Practices: A Multicenter Study.

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Financial discussions occur in about 28% of academic oncology visits, often initiated by patients and frequently unaddressed by clinicians, impacting care and causing distress.

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Area of Science:

  • Oncology
  • Health Services Research
  • Health Economics

Background:

  • Rising healthcare costs pose significant challenges for cancer patients.
  • Understanding patient-provider communication about financial toxicity is crucial.

Purpose of the Study:

  • To investigate the frequency, content, dynamics, and patterns of cost conversations in academic medical oncology.
  • To identify themes and impacts of financial discussions in routine oncology appointments.

Main Methods:

  • Analysis of 529 audio recordings from routine oncology appointments.
  • Qualitative thematic analysis of transcribed conversations mentioning cost.
  • Prospective, three-site communication study.

Main Results:

  • Financial issues were discussed in 28% of encounters, averaging less than 2 minutes.
  • Patients/caregivers initiated most cost discussions (106/151), with 40% unacknowledged by clinicians.
  • Key themes included insurance, drug costs, and impact on decision-making, work processes, and patient behaviors like self-rationing.

Conclusions:

  • Financial concerns are prevalent in academic oncology, often brief and unaddressed.
  • These discussions influence medical decisions, work processes, and contribute to patient distress.
  • Addressing identified gaps is essential for supporting cancer patients facing high costs.