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Encounter Decision Aids Can Prompt Breast Cancer Surgery Cost Discussions: Analysis of Recorded Consultations

Author

Listed:
  • Mary C. Politi

    (Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA)

  • Renata W. Yen

    (Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA)

  • Glyn Elwyn

    (Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA)

  • Natasha Kurien

    (Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
    Catalyst, Center for the Advancement of Team Science, Analytics, and Systems Thinking, The Ohio State University College of Medicine, Columbus, OH, USA)

  • Sophie G. Czerwinski

    (Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA)

  • Danielle Schubbe

    (Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA)

  • Catherine H. Saunders

    (Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA)

  • Marie-Anne Durand

    (Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA)

Abstract

Background. Patients frequently worry about care costs, but clinicians seldom address the topic. Cost information is not typically included in patient decision aids (DAs). We examined whether including cost information in an encounter DA, with clinician training, influenced cost conversations. Method. As part of a larger trial, 14 surgeons from 4 cancer centers were randomized to 1 of 3 interventions: (1) Picture Option Grid DA that included a prompt to discuss relative treatment costs, hereafter called “cost prompt group†; (2) a text-only Option Grid DA that did not include cost information; (3) usual care. Groups 2 and 3 hereafter are referred to as “non-cost prompt groups.†Adult (18+) female patients, with stages I-IIIA breast cancer, eligible for both breast-conserving surgery and mastectomy were included. We gave surgeons feedback about adherence to the study protocol at 3, 6, and 12-months. We adapted a checklist to code the content of the audio-recorded clinical encounters. Results. 424/622 (68%) patients consented; 311 (73%) were eligible and successfully recorded (143 in the cost prompt group, 168 in the non-cost prompt groups). Costs were discussed in 132/311 (42.4%) encounters, and occurred more often in the cost prompt versus non-cost prompt groups (66.7% versus 33.3%; p

Suggested Citation

  • Mary C. Politi & Renata W. Yen & Glyn Elwyn & Natasha Kurien & Sophie G. Czerwinski & Danielle Schubbe & Catherine H. Saunders & Marie-Anne Durand, 2020. "Encounter Decision Aids Can Prompt Breast Cancer Surgery Cost Discussions: Analysis of Recorded Consultations," Medical Decision Making, , vol. 40(1), pages 62-71, January.
    • Handle: RePEc:sae:medema:v:40:y:2020:i:1:p:62-71
    DOI: 10.1177/0272989X19893308
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