Parents' perspectives on cost conversations in pediatric asthma care: Findings from a qualitative interview study

Asthma care teams may be well-positioned to help parents navigate the high cost of pediatric asthma care, but little is known about how cost concerns are addressed in specialty clinics. To inform future interventions to support cost conversations and reduce cost burden, we sought to understand how parents and asthma care teams discuss costs, as well as parents' preferences for cost conversations.

We interviewed 21 parents with asthma care cost concerns recruited from a large pediatric asthma specialty clinic in North Carolina. We used thematic analysis to qualitatively describe parents' experiences of and preferences for cost conversations.

Parents described incurring a range of direct and indirect asthma care costs, with direct costs being especially burdensome for commercially-insured children. Parents wanted cost conversations to be a routine part of office visits to reduce assumptions and stigma about their ability to afford care. Yet, cost conversations were inconsistent. When cost conversations did occur, the care team often found ways to reduce costs, such as switching to lower-cost medications. Most parents believed that both families and the asthma care team would benefit from having more cost-related information. Parents had mixed views on having cost conversations in front of their children.

Findings of our qualitative study suggest that asthma care teams have opportunities to address and destigmatize parents' financial concerns by making cost conversations part of routine care.

Parents want asthma care teams to regularly initiate cost of care conversations, while carefully considering their preferences for privacy when discussing costs in front of children. Parents and care teams likely need more information about costs and available resources to maximize the impact of these conversations.