Talking about the Cost of Care: A Critical Component of Shared Decision Making Patient and Provider Perspectives

2020 ◽  
Vol 112 (5) ◽  
pp. 503-506
Author(s):  
Gwen Darien ◽  
Christine Wilson ◽  
Alan Balch ◽  
Rebekah Angove
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Cost Of Care ◽  
Shared Decision ◽  
Critical Component ◽  
Provider Perspectives ◽  
The Cost ◽  
Patient And Provider Perspectives

Talking About the Cost of Care: A Critical Component of Shared Decision Making

2020 ◽  
Vol 112 (2) ◽  
pp. 225-228
Author(s):  
Gwen Darien ◽  
Christine Wilson ◽  
Alan Balch ◽  
Rebekah Angove
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Cost Of Care ◽  
Shared Decision ◽  
Critical Component ◽  
The Cost

scholarly journals Exploring the Cost Effectiveness of Shared Decision Making for Choosing between Disease-Modifying Drugs for Relapsing-Remitting Multiple Sclerosis in the Netherlands: A State Transition Model

2020 ◽  
Vol 40 (8) ◽  
pp. 1003-1019
Author(s):  
Ingrid E. H. Kremer ◽  
Mickael Hiligsmann ◽  
Josh Carlson ◽  
Marita Zimmermann ◽  
Peter J. Jongen ◽  
...  
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Shared Decision Making ◽  
State Transition ◽  
Transition Model ◽  
Shared Decision ◽  
Relapsing Remitting ◽  
State Transition Model ◽  
The Cost ◽  
Relapsing Remitting Multiple Sclerosis

Background Up to 31% of patients with relapsing-remitting multiple sclerosis (RRMS) discontinue treatment with disease-modifying drug (DMD) within the first year, and of the patients who do continue, about 40% are nonadherent. Shared decision making may decrease nonadherence and discontinuation rates, but evidence in the context of RRMS is limited. Shared decision making may, however, come at additional costs. This study aimed to explore the potential cost-effectiveness of shared decision making for RRMS in comparison with usual care, from a (limited) societal perspective over a lifetime. Methods An exploratory economic evaluation was conducted by adapting a previously developed state transition model that evaluates the cost-effectiveness of a range of DMDs for RRMS in comparison with the best supportive care. Three potential effects of shared decision making were explored: 1) a change in the initial DMD chosen, 2) a decrease in the patient’s discontinuation in using the DMD, and 3) an increase in adherence to the DMD. One-way and probabilistic sensitivity analyses of a scenario that combined the 3 effects were conducted. Results Each effect separately and the 3 effects combined resulted in higher quality-adjusted life years (QALYs) and costs due to the increased utilization of DMD. A decrease in discontinuation of DMDs influenced the incremental cost-effectiveness ratio (ICER) most. The combined scenario resulted in an ICER of €17,875 per QALY gained. The ICER was sensitive to changes in several parameters. Conclusion This study suggests that shared decision making for DMDs could potentially be cost-effective, especially if shared decision making would help to decrease treatment discontinuation. Our results, however, may depend on the assumed effects on treatment choice, persistence, and adherence, which are actually largely unknown.

Measuring the impact of chemotherapy cost discussions between patients and providers at the time of prescribing.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 257-257 ◽  
Author(s):  
Ronan Joseph Kelly ◽  
Patrick M. Forde ◽  
Ashley Bagheri ◽  
Jenny Ahn ◽  
Arlene A. Forastiere ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Cost Of Care ◽  
Physician Satisfaction ◽  
Shared Decision ◽  
Cost Information ◽  
Nccn Guidelines ◽  
Negative Feelings ◽  
The Impact

257 Background: In 2007, the ASCO Cost of Care Task Force was established to deal with the soaring costs of cancer treatment in the United States. One of the key recommendations was that the cost of chemotherapy should be introduced into the patient-physician discussion from the outset. It is unknown if these discussions are occurring in academic Institutions and what if any is the impact on the doctor/patient relationship. Methods: The National Comprehensive Cancer Network (NCCN) Guidelines and the Eviti advisor platform were jointly used in an academic oncology center during the patient/doctor consultation to demonstrate treatment options to patients and display the costs at the time of prescribing to providers and patients alike. Questionnaires measured oncology providers attitudes to cost discussions and assessed physician satisfaction with the shared decision making process when costs are introduced into the patient/doctor relationship. Patients were interviewed before and after their doctor consultation to measure their satisfaction with the process using modifications of the shared decision making scale, satisfaction with decision scale and decisional conflict scale. Basic descriptive statistics were applied. Results: Only 5/18 oncologists (28%) reported feeling comfortable discussing costs with patients and just one (6%) admitted to regularly asking patients about financial difficulties. The majority (83%) of doctors reported that the NCCN guidelines should contain cost information. Seventy-one patients (42 females, 29 males) with metastatic breast (27%), lung (49%), and colorectal cancer (24%) have been interviewed. Interestingly, 70% of patients responded that no health care professional has ever discussed costs with them despite 57/71 (80%) rating this as very important information. The majority of patients (75%) had no negative feelings to hearing cost information. Only 4% admitted to developing significant negative feelings. Conclusions: In an era of rising co-pays, patients want cost of treatment discussions and these do not lead to negative feelings in the majority of patients. Additional training to prepare clinicians for how to discuss costs with their patients is needed.

Exploring Provider Reactions to Decision Aid Distribution and Shared Decision Making

2016 ◽  
Vol 37 (1) ◽  
pp. 113-126 ◽  
Author(s):  
Clarissa Hsu ◽  
David T. Liss ◽  
Dominick L. Frosch ◽  
Emily O. Westbrook ◽  
David Arterburn
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Decision Aid ◽  
Qualitative Interviews ◽  
Accurate Information ◽  
Shared Decision ◽  
Care Providers ◽  
Provider Attitudes ◽  
Provider Perspectives

Background. A critical component of shared decision making (SDM) is the role played by health care providers in distributing decision aids (DAs) and initiating SDM conversations. Existing literature indicates that decisions about designing and implementing DAs must take provider perspectives into account. However, little is known about how differences in provider attitudes across specialties may impact DA implementation and how provider attitudes may shift after DA implementation. Group Health’s Decision Aid Implementation project was carried out in six specialties using 12 video-based DAs for preference-sensitive conditions; this study focused on two of the six specialties. Design. In-depth, qualitative interviews with specialty care providers in two specialties—orthopedics and cardiology—at two time points during DA implementation. Data were analyzed using a thematic analysis approach. Results. We interviewed 19 care providers in orthopedics and cardiology. All respondents believed that providing patients with accurate information on their health conditions and treatment options was important and that most patients wanted an active role in decision making. However, respondents diverged in decision-making styles and views on the practicality and appropriateness of using the DAs and SDM. For example, cardiology specialists were ambivalent about DAs for coronary artery disease because many viewed DAs and SDM as unnecessary or inappropriate for this clinical condition. Provider attitudes towards DAs and SDM were generally stable over two years. Limitations. Limitations include a lack of patient perspectives, social desirability bias, and possible selection bias. Conclusions. Successfully implementing DAs in clinical practice to promote SDM requires addressing individual provider attitudes, beliefs, and knowledge of SDM by specialty. During DA development and implementation, providers should be asked for input about the specific conditions and care processes that are most appropriate for SDM.

scholarly journals Patients’ views of shared decision making in inflammatory bowel disease: a survey in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dingting Xu ◽  
Hanyun Zhang ◽  
Yan Chen
Keyword(s):  
Decision Making ◽  
Inflammatory Bowel Disease ◽  
Shared Decision Making ◽  
Bowel Disease ◽  
Influential Factors ◽  
Learning Ability ◽  
Chinese Patients ◽  
Shared Decision ◽  
Inflammatory Bowel ◽  
The Cost

Abstract Background Recently, decision-making process has become increasingly complex. But there is limited information on Chinese patients’ views of shared decision making (SDM) in inflammatory bowel disease (IBD). This questionnaire investigation aimed to understand Chinese patients’ perspectives and expectations of SDM in IBD and analyze the possible factors that influence their views. Methods An online survey was conducted from July 19th to 24th, 2020. A total of 1118 patients completed the survey. Results One-third of patients were dissatisfied with the current decision-making model, and the satisfaction of inpatients was lower than that of outpatients. 84% of patients preferred to participate in SDM, who were young and had a high education level, high income, commercial insurance, strong learning ability and knowledge of SDM. Most of those who did not want to participate (72%) were worried about the cost. The kind of medicine (948, 84.8%), surgical indications (505, 45.2%) and operation methods (482, 43.1%) were the topics that patients thought most require SDM. Side effects of medicine (837, 74.9%), costs of therapy (675, 60.4%), and surgical risks (563, 50.4%) were considered to be the most influential factors for SDM. 52.7% of all patients hoped experts in different disciplines would participate in SDM. The most desirable amount of time for discussion was 30 to 60 min (562/1118, 50.3%), that were associated with the cost of SDM. Conclusion We can meet the needs of patients by reducing costs and strengthening online patient education and exploring a model suitable for Chinese IBD patients.

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