So Young Kim1,2, Dong Wook Shin3, Boyoung Park4,5, Juhee Cho6,7, Jae Hwan Oh8, Sun Seog Kweon9, Hye Sook Han1,2, Hyung Kook Yang5, Keeho Park5, Jong-Hyock Park10,11. 1. College of Medicine, Graduate School of Health Science Business Convergence, Chungbuk National University, 1, Chungdae-ro, Seowon-gu, Cheongju, Chungcheongbuk-do, 28644, Republic of Korea. 2. Chungbuk National University Hospital, Cheongju, Republic of Korea. 3. Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Seoul, Republic of Korea. 4. Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea. 5. National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea. 6. Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 7. Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea. 8. Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea. 9. Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea. 10. College of Medicine, Graduate School of Health Science Business Convergence, Chungbuk National University, 1, Chungdae-ro, Seowon-gu, Cheongju, Chungcheongbuk-do, 28644, Republic of Korea. jonghyock@chungbuk.ac.kr. 11. National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea. jonghyock@chungbuk.ac.kr.
Abstract
PURPOSE: We assessed cost communication between cancer patients, caregivers, and oncologists and identified factors associated with communication concordance. METHODS: A national, multicenter, cross-sectional survey of patient-caregiver-oncologist triads was performed, and 725 patient-caregiver pairs, recruited by 134 oncologists in 13 cancer centers, were studied. Discordance in preferences and experiences regarding cost communication between patients, caregivers, and oncologists were assessed. Hierarchical generalized linear models were used to identify predictors of concordance and to identity the possible association of concordance with patient satisfaction and degree of trust in the physician. RESULTS: Although the oncologists thought that patients would be affected by the cost of care, only half of them were aware of the subjective burden experienced by their patients, and the degree of concordance for this parameter was very low (weighted kappa coefficient = 0.06). Caregivers consistently showed similar preferences to those of the patients. After controlling for covariates, the education level of patients [adjusted odds ratio (aOR) for > 12 vs. < 9 years, 2.92; 95% confidence interval (CI), 1.87-4.56], actual out-of-pocket costs [aOR for ≥ 8 million vs. < 2 million Korean Won, 0.56; 95% CI, 0.34-0.89], and physician age (aOR for ≥ 55 vs. < 45 years, 1.83; 95% CI, 1.04-3.21) were significant. CONCLUSIONS: The results show underestimation by oncologists regarding the subjective financial burden on a patient, and poor patient-physician concordance in cost communication. Oncologists should be more cognizant of patient OOP costs that are not indexed by objective criteria, but instead involve individual patient perceptions.
PURPOSE: We assessed cost communication between cancerpatients, caregivers, and oncologists and identified factors associated with communication concordance. METHODS: A national, multicenter, cross-sectional survey of patient-caregiver-oncologist triads was performed, and 725 patient-caregiver pairs, recruited by 134 oncologists in 13 cancer centers, were studied. Discordance in preferences and experiences regarding cost communication between patients, caregivers, and oncologists were assessed. Hierarchical generalized linear models were used to identify predictors of concordance and to identity the possible association of concordance with patient satisfaction and degree of trust in the physician. RESULTS: Although the oncologists thought that patients would be affected by the cost of care, only half of them were aware of the subjective burden experienced by their patients, and the degree of concordance for this parameter was very low (weighted kappa coefficient = 0.06). Caregivers consistently showed similar preferences to those of the patients. After controlling for covariates, the education level of patients [adjusted odds ratio (aOR) for > 12 vs. < 9 years, 2.92; 95% confidence interval (CI), 1.87-4.56], actual out-of-pocket costs [aOR for ≥ 8 million vs. < 2 million Korean Won, 0.56; 95% CI, 0.34-0.89], and physician age (aOR for ≥ 55 vs. < 45 years, 1.83; 95% CI, 1.04-3.21) were significant. CONCLUSIONS: The results show underestimation by oncologists regarding the subjective financial burden on a patient, and poor patient-physician concordance in cost communication. Oncologists should be more cognizant of patient OOP costs that are not indexed by objective criteria, but instead involve individual patient perceptions.
Entities:
Keywords:
Concordance; Out-of-pocket costs; Patient-physician communication
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