Communication of Cost in Thyroidectomy: A Mixed-Methods Analysis of Financial Toxicity

To assess cost information provided to patients undergoing thyroidectomy.

Explanatory sequential mixed-methods study.

Single academic medical center.

Adults who underwent thyroidectomy between 1/2021 and 1/2024 completed a survey about financial toxicity. Purposive sampling identified survey respondents for semi-structured interviews to explore experiences related to cost communication. Qualitative data were thematically analyzed.

Of 167 survey respondents, most were female (77.8%), white (83.8%), and underwent total thyroidectomy (65.3%). Nearly one-third experienced moderate to severe financial toxicity. Forty-one percent felt "not at all" informed about costs, while 20% sought preoperative cost information, most commonly from insurers (82.4%). Education was significantly associated with feeling cost-informed, while lowest- and highest-income, younger, and female patients trended toward greater cost-seeking behavior. Thirty-five respondents were invited for an interview; 20 consented. Almost all participants recalled no cost discussion with their care team. Several felt like they "had to" have surgery, regardless of cost, and many were surprised by copays, missed work, and medication costs. Some wished they had received estimates or information about financial resources. Participants identified insurers as a source for cost information but received vague communication regarding coverage. A few stated that while better cost information would not have changed their treatment decision, it would have better prepared them for the financial impact.

Patients undergoing thyroidectomy appear to be insufficiently informed of costs before surgery. Improved cost communication by care teams and hospital systems could improve preparedness and mitigate financial toxicity, as reliance on insurers alone appears inadequate.