scholarly journals Physician-patient communication of costs and financial burden of cancer and its treatment: a systematic review of clinical guidelines

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anupriya Agarwal ◽  
Ann Livingstone ◽  
Deme J. Karikios ◽  
Martin R. Stockler ◽  
Philip J. Beale ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Financial Burden ◽  
Risk Groups ◽  
Healthcare Team ◽  
Cost Information ◽  
Eligibility Criteria ◽  
Anticancer Treatment ◽  
Costs Of Treatment ◽  
American Society ◽  
Physician Patient

Abstract Background Optimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. The American Society of Clinical Oncology (ASCO) has recommended clinicians discuss costs of cancer care with patients to enhance shared decision-making. We sought information to guide oncologists’ discussions with patients about these costs. Methods We searched Medline, EMBASE and clinical practice guideline databases from January 2009 to 1 June 2019 for recommendations about discussing the costs of care and financial burden. Guideline quality was assessed with the AGREE-II instrument. Results Twenty-seven guidelines met our eligibility criteria, including 16 from ASCO (59%). 21 of 27 (78%) guidelines included recommendations about discussion or consideration of treatment costs when prescribing, with information about actual costs in four (15%). Recognition of the risk of financial burden or financial toxicity was described in 81% (22/27) of guidelines. However, only nine guidelines (33%) included information about managing the financial burden. Conclusions Current clinical practice guidelines have little information to guide physician-patient discussions about costs of anticancer treatment and management of financial burden. This limits patients’ ability to control costs of treatment, and for the healthcare team to reduce the incidence and severity of financial burden. Current guidelines recommend clinician awareness of price variability and high costs of treatment. Clinicians are recommended to explore cost concerns and address financial worries, especially in high risk groups. Future guidelines should include advice on facilitating cost transparency discussions, with provision of cost information and resources.

scholarly journals Discussing the Costs and Financial Burden of Cancer and its Treatment: A Systematic Review of Clinical Guidelines

2021 ◽  
Author(s):  
Anupriya Agarwal ◽  
Ann Livingstone ◽  
Deme J Karikios ◽  
Martin R Stockler ◽  
Philip J Beale ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Financial Burden ◽  
Risk Groups ◽  
Healthcare Team ◽  
Limited Information ◽  
Eligibility Criteria ◽  
Guideline Quality ◽  
Anticancer Treatment ◽  
Costs Of Treatment ◽  
American Society

Abstract BackgroundOptimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. The American Society of Clinical Oncology (ASCO) has recommended clinicians discuss costs of cancer care with patients to enhance shared decision-making. We sought information to guide oncologists’ discussions with patients about these costs.MethodsWe searched Medline, EMBASE and clinical practice guideline databases from January 2009 to 1 June 2019 for recommendations about discussing the costs of care and financial burden. Guideline quality was assessed with the AGREE-II instrument.ResultsTwenty-seven guidelines met our eligibility criteria, including 16 from ASCO (59%). 21 of 27 (78%) guidelines included recommendations about discussion or consideration of treatment costs when prescribing, with information about actual costs in four (15%). Recognition of the risk of financial burden or financial toxicity was described in 81% (22/27) of guidelines. However, only nine guidelines (33%) included information about managing the financial burden.ConclusionsCurrent clinical practice guidelines have limited information to guide discussions regarding costs of anticancer treatment and management of financial burden. This limits the ability of patients to control the costs of treatment, and of the healthcare team to reduce the incidence and severity of financial burden. Current guidelines recommend clinician awareness of price variability and high costs of treatment. Clinicians are recommended to explore cost concerns and address financial worries, especially in high risk groups. Future guidelines should include advice on facilitating cost transparency discussions, with provision of costs information and resources.

scholarly journals Longitudinal Weight Outcomes From a Behavioral Lifestyle Intervention in Clinical Practice

2019 ◽  
Vol 45 (5) ◽  
pp. 529-543 ◽  
Author(s):  
Robert J. Romanelli ◽  
Hsiao-Ching Huang ◽  
Vidita Chopra ◽  
Jun Ma ◽  
Elizabeth M. Venditti ◽  
...  
Keyword(s):  
Weight Loss ◽  
Clinical Practice ◽  
Cardiometabolic Risk ◽  
Care Delivery ◽  
Lifestyle Change ◽  
Risk Groups ◽  
Health Care Delivery System ◽  
Eligibility Criteria ◽  
Weight Outcomes ◽  
Baseline Weight

Purpose The purpose of this electronic health record (EHR)–based retrospective cohort study was to characterize a population of patients participating in a 12-month, lifestyle change program in a community-based health system and to examine longitudinal weight outcomes. Methods Program participants were identified in the EHRs of a health care delivery system across 18 sites between 2010 and 2017. Outcomes were mean weight change and proportion of patients with ≥5% weight loss through 24 months from program initiation. Results Among 4463 program participants, 3156 met study eligibility criteria, with a mean ± SD age of 53.5 ± 13.1 years; 77.7% were women. Mean baseline weight ± SD was 101.3 ± 23.8 kg. Three main cardiometabolic risk groups were identified: prediabetes/high risk for diabetes (47.3%), overweight/obese in the absence of elevated diabetes risk (27.2%), and existing diabetes (23.9%). Maximal mean weight loss was 3.9% at 6 months from baseline. At 12 and 24 months from baseline, mean weight loss was 3.2% and 2.3%, respectively, with 31% and 29% of participants attaining ≥5% weight loss. Long-term weight outcomes were similar across risk groups. Conclusions A lifestyle change program in a clinical practice setting is associated with modest weight loss, sustained through 24 months, among participants with a range of cardiometabolic risk factors. More than one-quarter of participants achieve ≥5% weight loss, regardless of cardiometabolic risk.

Recommendations from clinical practice guidelines on discussion of costs of care in adult patients with advanced cancer: A systematic review.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23175-e23175
Author(s):  
Anupriya Agarwal ◽  
Deme John Karikios ◽  
Martin R. Stockler ◽  
Philip James Beale ◽  
Rachael L. Morton
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Financial Burden ◽  
Cost Of Care ◽  
Optimal Timing ◽  
Costs Of Care ◽  
Anticancer Treatment ◽  
Clinician Communication ◽  
The Cost

e23175 Background: Optimising the care of cancer patients without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. The 2009 American Society of Clinical Oncology’s (ASCO) Guidance Statement on the Cost of Cancer Care recommends that ‘patient-physician discussions regarding the cost of care are an important component of high-quality care’.(1) We sought information for oncologists to facilitate patient-clinician communication about the costs of care in published clinical practice guidelines (CPGs). Methods: We searched MEDLINE, EMBASE and multiple databases of CPG from January 2008 to 1st June 2018 for recommendations about discussing the costs of care. We assessed quality with the AGREE II instrument for the assessment of guidelines. Results: We identified 471 publications, of which 25 guidelines met our eligibility criteria. Most guidelines were from ASCO (64%, 16/25) and the Scottish Intercollegiate Guidelines Network (SIGN, 24%, 6/25). Guidelines included recommendations on discussion or consideration of treatment costs when prescribing in 52% (13/25) with information about actual costs in only 20% (5/25). Recognition of the risk of financial burden or financial toxicity was described in 60% (15/25) of guidelines, however, only a minority of these, 28% (7/25) contained information regarding management of patients with financial concerns. Conclusions: Current CPGs have limited information to guide patient-clinician communication about the costs of anticancer treatment and management of financial burden. Future guidelines should contain more information about the optimal timing, frequency, and content of these discussions. Future guidelines should include more guidance about how oncologists should communicate the costs of care accurately and transparently, along with suggestions to reduce financial burden.

scholarly journals Professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness: A systematic review using the framework method and pillar process

2021 ◽  
pp. 026921632110321
Author(s):  
Florence Reedy ◽  
Mark Pearson ◽  
Sarah Greenley ◽  
Joseph Clark ◽  
David C Currow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
A Priori ◽  
Synthesis Method ◽  
Patient Characteristics ◽  
Severe Illness ◽  
Pharmacological Interventions ◽  
Eligibility Criteria ◽  
Treatment Regimens ◽  
Appraisal Tool

Background: In combination with non-pharmacological interventions, opioids may safely reduce chronic breathlessness in patients with severe illness. However, implementation in clinical practice varies. Aim: To synthesise the published literature regarding health professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness, identifying issues which influence implementation in clinical practice. Design: Systematic review and synthesis using the five-stage framework synthesis method. Data sources: Three electronic databases (MEDLINE, Embase via OVID, ASSIA via Proquest) were searched (March 2020) using a predefined search strategy. Studies were also citation chained from key papers. Papers were screened against a priori eligibility criteria. Data were extracted from included studies using the framework synthesis method. Qualitative and quantitative data were synthesised using the pillar process. Included studies were critically appraised using the Mixed-Methods Appraisal Tool. Results: After de-duplication, 843 papers were identified. Following screening, 22 studies were included. Five themes were developed: (i) clinician/patient characteristics, (ii) education/knowledge/experience, (iii) relationship between clinician/family, (iv) clinician/patient fear of opioids and (v) regulatory issues. Conclusions: There are significant barriers and enablers to the use of opioids for the symptomatic reduction of chronic breathlessness based on the knowledge, views and attitudes of clinicians, patients and families. Clinicians’ interactions with patients and their families strongly influences adherence with opioid treatment regimens for chronic breathlessness. Clinicians’, patients’ and families’ knowledge about the delicate balance between benefits and risks is generally poor. Education for all, but particularly clinicians, is likely to be a necessary (but insufficient) factor for improving implementation in practice.

scholarly journals A57 THE USE AND INTERPRETATION OF HLA-DQ2/DQ8 GENOTYPING BY PEDIATRIC GASTROENTEROLOGISTS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 14-15
Author(s):  
B Moreau ◽  
E Robidoux
Keyword(s):  
Risk Groups ◽  
Risk Classification ◽  
Low Risk ◽  
Risk Alleles ◽  
Seronegative Patient ◽  
Espghan Guidelines ◽  
Recent Classification ◽  
American Society ◽  
Hla Dq2

Abstract Background A recent classification of high and low risk alleles associated with celiac disease (CD) shows that the presence of a single allele (DQA1*05 or DQB1*02; coding together for HLA-DQ2), without a positive genotype (HLA-DQ2 and or HLA-DQ8), represents a risk of developing the disease. Aims The aim of this study is to evaluate the use and interpretation of the HLA-DQ2/DQ8 genotyping by pediatric gastroenterologists, as there is no study on the matter and the latest guidelines do not address this risk classification. Methods A web-based survey was sent by email to all NASPGHAN (North American society of pediatric gastroenterolgy, hepatology and nutrition) members. Results Results 294 pediatric gastroenterologists sent a complete survey. 86,1% use the HLA-DQ2/DQ8 genotyping according mainly to the NASPGHAN and ESPGHAN guidelines. The main indications considered were to exclude CD in a patient on a gluten-free diet with a resolution of his symptoms and in a seronegative patient with equivocal biopsies. A minority would consider the genotyping for screening high risk groups or for making a diagnosis in children with high specific CD antibodies and strong clinical suspicion without performing biopsies, as suggested by the ESPGHAN guidelines. The alleles associated with CD are not well known, but 76,7% the participants are aware of the risk classification. While only 62,8% have access to the complete genotype, 47,8% consider it useful. Nevertheless, 82,6% would still want to know the presence of a low risk allele. Conclusions The risk classification of alleles related to CD warrants a modification of the genotyping result with access to the alleles and an adaptation of the guidelines. Funding Agencies None

Questions Collaborative Dexamethasone Trial

PEDIATRICS ◽  
1992 ◽  
Vol 89 (6) ◽  
pp. 1266-1266
Author(s):  
ROSAMOND JONES ◽  
ADRIAN GRANT ◽  
Keyword(s):  
Clinical Practice ◽  
Random Sample ◽  
Human Beings ◽  
Eligibility Criteria ◽  
Clinical Uncertainty ◽  
Trial Entry ◽  
Selection Of

In Reply.— We are glad to respond to Dr MacMahon's letter about the generalizability of the results of our trial. Basing trial entry on `clinical uncertainty' is actually one of the strengths of this trial.1 No trial can ever include a random sample of all human beings who meet the eligibility criteria; there is always selection of subjects (whatever the entry criteria). Inevitably, therefore, at some point there has to be a leap of faith from the evidence to clinical practice.2

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