Maria Pisu, PhD; Yu-Mei Schoenberger, PhD; Ivan Herbey, MD; Aquila Brown-Galvan, MPH; Margaret I. Liang, MD; Kevin Riggs, MD; Karen Meneses, PhD, RN†
Acknowledgment: The authors thank the Institute for Cancer Outcomes and Survivorship and Comprehensive Cancer Center, University of Alabama at Birmingham, for their support.
Financial Support: By the Robert Wood Johnson Foundation (grant 74122).
Disclosures: Dr. Pisu reports a grant from the Robert Wood Johnson Foundation. Dr. Riggs reports grants from the Agency for Healthcare Research and Quality during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2117.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer, and Johnson & Johnson. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Corresponding Author: Maria Pisu, PhD, Division of Preventive Medicine, University of Alabama at Birmingham, MT 636, 1720 2nd Avenue South, Birmingham, AL 35294-4410; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Pisu: Division of Preventive Medicine, University of Alabama at Birmingham, MT 636, 1720 2nd Avenue South, Birmingham, AL 35294-4410.
Dr. Schoenberger: Division of Preventive Medicine, University of Alabama at Birmingham, MT 617, 1720 2nd Avenue South, Birmingham, AL 35294-4410.
Dr. Herbey: Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, BBRB 220A, 1720 2nd Avenue South, Birmingham, AL 35294-2170
Ms. Brown-Galvan: Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, MT 401, 1720 2nd Avenue South, Birmingham, AL 35294-4410.
Dr. Liang: Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Building 176F, Room 10250, Birmingham, AL 35233.
Dr. Riggs: Division of Preventive Medicine, University of Alabama at Birmingham, MT 610, 1720 2nd Avenue South, Birmingham, AL 35294-4410.
Author Contributions: Conception and design: M. Pisu, K. Meneses.
Analysis and interpretation of the data: M. Pisu, Y.M. Schoenberger, I. Herbey, M.I. Liang, K. Riggs, K. Meneses.
Drafting of the article: M. Pisu, I. Herbey, K. Meneses.
Critical revision of the article for important intellectual content: Y.M. Schoenberger, M.I. Liang, K. Riggs, K. Meneses.
Final approval of the article: M. Pisu, Y.M. Schoenberger, I. Herbey, A. Brown-Galvan, M.I. Liang, K. Riggs, K. Meneses.
Provision of study materials or patients: A. Brown-Galvan.
Obtaining of funding: M. Pisu.
Administrative, technical, or logistic support: A. Brown-Galvan.
Collection and assembly of data: M. Pisu, Y.M. Schoenberger, A. Brown-Galvan, K. Meneses.
Despite recommendations to discuss the cost of care (CoC) with patients with cancer, little formal guidance is available on how to conduct these sensitive conversations in ways that are acceptable to both patients and providers.
To explore the perspectives of patients and medical and nonmedical cancer center staff on CoC conversations.
In individual interviews, participants were asked to discuss the content of, timing of, and ideal person to hold CoC conversations. Interviews were transcribed verbatim. Content was analyzed to identify emerging essential elements.
Division of Preventive Medicine, University of Alabama at Birmingham.
42 women aged 60 to 79 years with a history of breast cancer and 20 cancer center staff (6 physicians, 4 nurses, 5 patient navigators, 3 social workers, and 2 billing specialists).
Both patients and providers identified reassurance and action as essential elements of CoC conversations. Participants expressed the importance of reassurance that recommended medical care would not be affected by affordability challenges. Action was intended as discussions on ways to help patients cover treatment-related costs, such as discussion of payment plans or linkage to financial resources. Optimal timing for CoC conversations was felt to be after an initial consult visit but before treatment started. The person to hold these conversations should be compassionate, helpful, and knowledgeable of the patient's specific situation (for example, treatment plan, insurance coverage) and of the resources available to attain the patient's goals of care.
Interviews were limited to older breast cancer survivors and staff at 1 institution.
Conversations about CoC extend beyond discussing costs and must be sensitive to the vulnerability experienced by patients. These findings can guide training of personnel involved in CoC conversations.
Robert Wood Johnson Foundation.
Study flow diagram.
Table 1. Characteristics of 42 Breast Cancer Survivor Participants
Table 2. Illustrative Quotations From Survivors' Interviews*
Table 3. Illustrative Quotations From Providers' Interviews*
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In this video, Maria Pisu, PhD, and Margaret I. Liang, MD, offer additional insight into the article, "Perspectives on Conversations About Costs of Cancer Care of Breast Cancer Survivors and Cancer Center Staff. A Qualitative Study."
Pisu M, Schoenberger Y, Herbey I, et al. Perspectives on Conversations About Costs of Cancer Care of Breast Cancer Survivors and Cancer Center Staff: A Qualitative Study. Ann Intern Med. 2019;170:S54–S61. doi: https://doi.org/10.7326/M18-2117
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Published: Ann Intern Med. 2019;170(9_Supplement):S54-S61.
Breast Cancer, Cancer Survivorship, Hematology/Oncology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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