Rachel A Greenup1,2,3,4, Christel N Rushing5,6, Laura J Fish5,7,8, Whitney O Lane9, Jeffrey M Peppercorn10, Emily Bellavance11, Lisa Tolnitch9, Terry Hyslop5,6, Evan R Myers12,13, S Yousuf Zafar14,5,7,12, E Shelley Hwang9,5. 1. Department of Surgery, Duke University, Durham, NC, USA. rachel.greenup@duke.edu. 2. Department of Population Health Sciences, Duke University, Durham, NC, USA. rachel.greenup@duke.edu. 3. Duke Cancer Institute, Duke University, Durham, NC, USA. rachel.greenup@duke.edu. 4. Duke Cancer Control and Population Sciences, Duke University, Durham, NC, USA. rachel.greenup@duke.edu. 5. Duke Cancer Institute, Duke University, Durham, NC, USA. 6. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA. 7. Duke Cancer Control and Population Sciences, Duke University, Durham, NC, USA. 8. Duke School of Medicine, Duke University, Durham, NC, USA. 9. Department of Surgery, Duke University, Durham, NC, USA. 10. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. 11. University of Maryland School of Medicine, Baltimore, MD, USA. 12. Department of Medicine, Duke University, Durham, NC, USA. 13. Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA. 14. Department of Population Health Sciences, Duke University, Durham, NC, USA.
Abstract
BACKGROUND: Cancer treatment costs are not routinely addressed in shared decisions for breast cancer surgery. Thus, we sought to characterize cost awareness and communication among surgeons treating breast cancer. METHODS: We conducted a self-administered, confidential electronic survey among members of the American Society of Breast Surgeons from 1 July to 15 September 2018. Questions were based on previously published or validated survey items, and assessed surgeon demographics, cost sensitivity, and communication. Descriptive summaries and cross-tabulations with Chi-square statistics were used, with exact tests where warranted, to assess findings. RESULTS: Of those surveyed (N = 2293), 598 (25%) responded. Surgeons reported that 'risk of recurrence' (70%), 'appearance of the breast' (50%), and 'risks of surgery' (47%) were the most influential on patients' decisions for breast cancer surgery; 6% cited out-of-pocket costs as significant. Over half (53%) of the surgeons agreed that doctors should consider patient costs when choosing cancer treatment, yet the majority of surgeons (58%) reported 'infrequently' (43%) or 'never' (15%) considering patient costs in medical recommendations. The overwhelming majority (87%) of surgeons believed that patients should have access to the costs of their treatment before making medical decisions. Surgeons treating a higher percentage of Medicaid or uninsured patients were more likely to consistently consider costs (p < 0.001). Participants reported that insufficient knowledge or resources (61%), a perceived inability to help with costs (24%), and inadequate time (22%) impeded cost discussions. Notably, 20% of participants believed that discussing costs might impact the quality of care patients receive. CONCLUSIONS: Cost transparency remains rare, however in shared decisions for breast cancer surgery, improved cost awareness by surgeons has the potential to reduce financial hardship.
BACKGROUND:Cancer treatment costs are not routinely addressed in shared decisions for breast cancer surgery. Thus, we sought to characterize cost awareness and communication among surgeons treating breast cancer. METHODS: We conducted a self-administered, confidential electronic survey among members of the American Society of Breast Surgeons from 1 July to 15 September 2018. Questions were based on previously published or validated survey items, and assessed surgeon demographics, cost sensitivity, and communication. Descriptive summaries and cross-tabulations with Chi-square statistics were used, with exact tests where warranted, to assess findings. RESULTS: Of those surveyed (N = 2293), 598 (25%) responded. Surgeons reported that 'risk of recurrence' (70%), 'appearance of the breast' (50%), and 'risks of surgery' (47%) were the most influential on patients' decisions for breast cancer surgery; 6% cited out-of-pocket costs as significant. Over half (53%) of the surgeons agreed that doctors should consider patient costs when choosing cancer treatment, yet the majority of surgeons (58%) reported 'infrequently' (43%) or 'never' (15%) considering patient costs in medical recommendations. The overwhelming majority (87%) of surgeons believed that patients should have access to the costs of their treatment before making medical decisions. Surgeons treating a higher percentage of Medicaid or uninsured patients were more likely to consistently consider costs (p < 0.001). Participants reported that insufficient knowledge or resources (61%), a perceived inability to help with costs (24%), and inadequate time (22%) impeded cost discussions. Notably, 20% of participants believed that discussing costs might impact the quality of care patients receive. CONCLUSIONS: Cost transparency remains rare, however in shared decisions for breast cancer surgery, improved cost awareness by surgeons has the potential to reduce financial hardship.
Authors: Nicholas L Berlin; Paul Abrahamse; Adeyiza O Momoh; Steven J Katz; Reshma Jagsi; Ann S Hamilton; Kevin C Ward; Sarah T Hawley Journal: Cancer Date: 2021-11-30 Impact factor: 6.860