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Communication of costs and financial burdens between cancer patients and healthcare providers: a qualitative systematic review and meta-synthesis

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Abstract

Objectives

The aim of this study was to synthesize qualitative research regarding communication of costs and financial burdens between patients and healthcare providers to provide evidence for the subsequent development of intervention programs.

Methods

Studies published prior to 11 February 2023 were collected from electronic databases, including PubMed/MEDLINE, MEDLINE (Ovid), Web of Science, EMBASE (Ovid), CINAHL (EBSCO), and ProQuest. A checklist for qualitative research drawn from the Joanna Briggs Institute Reviewer’s Manual was applied to assess the quality of the included studies. Meta-aggregation was performed to synthesize the findings of the included studies.

Results

Four synthesized findings were derived from 15 studies: cost communication offered more benefits than drawbacks, and most patients were willing to engage in cost communication; cost communication has been implemented in clinical practice but continued to face shortcomings and barriers; an expected cost communication should take into account timing, location, personnel, personality, and content; healthcare providers required education, information, tools, standardized processes, and policy and organizational support to increase their ability to deliver cost communication.

Conclusions

Cost communication can help optimize decision-making and reduce the risk of financial difficulties, as has been widely recognized by patients and healthcare providers. However, a complete clinical practice plan to facilitate cost communication has not yet been created.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249

    Article  PubMed  Google Scholar 

  2. Gordon LG, Beesley VL, Mihala G, Koczwara B, Lynch BM (2017) Reduced employment and financial hardship among middle-aged individuals with colorectal cancer. Eur J Cancer Care 26(5):e12744

  3. Gordon LG, Walker SM, Mervin MC, Lowe A, Smith DP, Gardiner RA et al (2017) Financial toxicity: a potential side effect of prostate cancer treatment among Australian men. Eur J Cancer Care 26(1):e12392

  4. Rugo HS, Rumble RB, Macrae E, Barton DL, Connolly HK, Dickler MN et al (2016) Endocrine therapy for hormone receptor-positive metastatic breast cancer: American Society of Clinical Oncology guideline. J Clin Oncol 34(25):3069–3103

    Article  CAS  PubMed  Google Scholar 

  5. Iragorri N, de Oliveira C, Fitzgerald N, Essue B (2021) The out-of-pocket cost burden of cancer care—a systematic literature review. Curr Oncol 28(2):1216–1248

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zafar SY (2016) Financial toxicity of cancer care: it’s time to intervene. J Natl Cancer Inst 108(5):djv370

  7. Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR (2017) Financial hardships experienced by cancer survivors: a systematic review. J Natl Cancer Inst 109(2):djw205

  8. Hunter WG, Hesson A, Davis JK, Kirby C, Williamson LD, Barnett JA et al (2016) Patient-physician discussions about costs: definitions and impact on cost conversation incidence estimates. BMC Health Serv Res 16:108

    Article  PubMed  PubMed Central  Google Scholar 

  9. Meropol NJ, Schrag D, Smith TJ, Mulvey TM, Langdon RM Jr, Blum D et al (2009) American Society of Clinical Oncology guidance statement: the cost of cancer care. J Clin Oncol 27(23):3868–3874

    Article  PubMed  Google Scholar 

  10. American Society of Clinical O (2018) American Society of Clinical Oncology position statement on addressing the affordability of cancer drugs. J Oncol Pract 14(3):187–92

    Article  Google Scholar 

  11. Hunter WG, Zhang CZ, Hesson A, Davis JK, Kirby C, Williamson LD et al (2016) What strategies do physicians and patients discuss to reduce out-of-pocket costs? Analysis of cost-saving strategies in 1,755 outpatient clinic visits. Med Decis Making 36(7):900–910

    Article  PubMed  PubMed Central  Google Scholar 

  12. Scott AM, Harrington NG (2021) Are cost-of-care conversations best practice? A qualitative study of oncologists’ attitudes and practice. Jco Oncol Pract 17(10):624

    Google Scholar 

  13. Harrington NG, Scott AM, Spencer EA (1982) Working toward evidence-based guidelines for cost-of-care conversations between patients and physicians: a systematic review of the literature. Soc Sci Med 2020(258):113084

    Google Scholar 

  14. Livingstone A, Agarwal A, Morton RL, Karikios DJ, Stockler MR, Beale PJ (2021) Physician-patient communication of costs and financial burden of cancer and its treatment: a systematic review of clinical guidelines. BMC Cancer 21(1):1036

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hannes K, Lockwood C (2011) Pragmatism as the philosophical foundation for the Joanna Briggs meta-aggregative approach to qualitative evidence synthesis. J Adv Nurs 67(7):1632–1642

    Article  PubMed  Google Scholar 

  16. Pearson A (2004) Balancing the evidence: incorporating the synthesis of qualitative data into systematic reviews. JBI Reports 2(2):45–64

    Article  Google Scholar 

  17. Aromataris E, Munn Z (2020) Chapter 2: systematic reviews of qualitative evidence. Available from: https://synthesismanual.jbi.global

  18. Zhu Z, Xing W, Zhang X, Hu Y, So WKW (2020) Cancer survivors’ experiences with financial toxicity: a systematic review and meta-synthesis of qualitative studies. Psychooncol 29(6):945–959

    Article  Google Scholar 

  19. Tong A, Flemming K, McInnes E, Oliver S, Craig J (2012) Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol 12:181

    Article  PubMed  PubMed Central  Google Scholar 

  20. Henrikson NB, Tuzzio L, Miyoshi J, Buist DS, Loggers ET (2014) Patient and oncologist discussions about cancer care costs. Support Care Cancer 22(4):961–967

    Article  PubMed  Google Scholar 

  21. Slavova-Azmanova N, Newton JC, Hohnen H, Saunders C, Johnson CE (2019) How communication between cancer patients and their specialists affect the quality and cost of cancer care. Support Care Cancer 27(12):4575–4585

    Article  PubMed  Google Scholar 

  22. Warsame R, Kennedy CC, Kumbamu A, Branda M, Fernandez C, Kimball B et al (2019) Conversations about financial issues in routine oncology practices: a multicenter study. J Oncol Pract 15(8):e690–e703

    Article  PubMed  PubMed Central  Google Scholar 

  23. Pisu M, Schoenberger Y-M, Herbey I, Brown-Galvan A, Liang MI, Riggs K et al (2019) Perspectives on conversations about costs of cancer care of breast cancer survivors and cancer center staff: a qualitative study. Ann Intern Med 170:S54–S61

    Article  PubMed  Google Scholar 

  24. Henrikson NB, Banegas MP, Tuzzio L, Lim C, Schneider JL, Walsh-Bailey C et al (2019) Workflow requirements for cost-of-care conversations in outpatient settings providing oncology or primary care: a qualitative, human-centered design study. Ann Intern Med 170(9_supp):S70–S8

  25. Wollins DS (2019) Optimizing cost discussions between oncologists and patients to reduce financial toxicity: a qualitative study of oncologist perspectives [Dr.P.H.]. The University of North Carolina at Chapel Hill, Ann Arbor, pp22–62

  26. Pisu M, Banegas MP, Liang MI, Tuzzio L, Henrikson NB (2020) How, when, and with whom should cost of care conversations occur? Preferences of two distinct cancer survivor groups. JCO Oncol Pract 16(9):E912–E921

    Article  PubMed  PubMed Central  Google Scholar 

  27. Haverfield MC, Singer AE, Gray C, Shelley A, Nash A, Lorenz KA (2020) Implementing routine communication about costs of cancer treatment: perspectives of providers, patients, and caregivers. Support Care Cancer : Off J Multinatl Assoc Support Care Cancer 28(9):4255–4262

    Article  CAS  Google Scholar 

  28. Arastu A, Patel A, Mohile SG, Ciminelli J, Kaushik R, Wells M et al (2020) Assessment of financial toxicity among older adults with advanced cancer. JAMA Netw Open 3(12):e2025810

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kaser E, Shaw J, Marven M, Swinburne L, Boyle F (2010) Communication about high-cost drugs in oncology—the patient view. Ann Oncol 21(9):1910–1914

    Article  CAS  PubMed  Google Scholar 

  30. Edward JS, Northrip KD, Welker A, Costich JF (2022) Medical-legal partnerships facilitate patient-provider cost of care conversations: a multisite qualitative study in the U.S. Clin Nurs Res 31(8):1500–9

    Article  PubMed  PubMed Central  Google Scholar 

  31. Suarez NRE, LaVecchia CM, Morrow AS, Fischer KM, Kamath C, Boehmer KR et al (2022) ABLE to support patient financial capacity: a qualitative analysis of cost conversations in clinical encounters. Patient Educ Couns 105(11):3249–3258

    Article  Google Scholar 

  32. Yeager KA, Zahnd WE, Eberth JM, Vanderpool RC, Rohweder C, Teal R, et al (2022) Financial navigation: staff perspectives on patients’ financial burden of cancer care. J Cancer Surviv. https://doi.org/10.1007/s11764-022-01175-2

  33. Zafar SY, Chino F, Ubel PA, Rushing C, Samsa G, Altomare I et al (2015) The utility of cost discussions between patients with cancer and oncologists. Am J Manag Care 21(9):607–615

    PubMed  Google Scholar 

  34. Bestvina CM, Zullig LL, Rushing C, Chino F, Samsa GP, Altomare I et al (2014) Patient-oncologist cost communication, financial distress, and medication adherence. J Oncol Pract 10(3):162–167

    Article  PubMed  Google Scholar 

  35. Espinoza Suarez NR, LaVecchia CM, Fischer KM, Kamath CC, Brito JP (2021) Impact of cost conversation on decision-making outcomes. Mayo Clin Proc Innov Qual Outcomes 5(4):802–810

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bullock AJ, Hofstatter EW, Yushak M, Buss MK (2012) Understanding patients’ attitudes toward communication about the cost of cancer care. J Oncol Pract 8(4):e50-8

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kim SY, Shin DW, Park B, Cho J, Oh JH, Kweon SS et al (2018) Cancer cost communication: experiences and preferences of patients, caregivers, and oncologists-a nationwide triad study. Support Care Cancer 26(10):3517–3526

    Article  PubMed  Google Scholar 

  38. Schickedanz A (2010) Of value: a discussion of cost, communication, and evidence to improve cancer care. Oncologist 15(Suppl 1):73–79

    Article  PubMed  Google Scholar 

  39. Hamel LM, Penner LA, Eggly S, Chapman R, Klamerus JF, Simon MS et al (2017) Do patients and oncologists discuss the cost of cancer treatment? An observational study of clinical interactions between African American patients and their oncologists. J Oncol Pract 13(3):e249–e258

    Article  PubMed  Google Scholar 

  40. Nipp RD, Sonet EM, Guy GP Jr (2018) Communicating the financial burden of treatment with patients. Am Soc Clin Oncol Educ Book 38:524–531

    Article  PubMed  Google Scholar 

  41. May JH, Cunningham PJ (2004) Tough trade-offs: medical bills, family finances and access to care. Issue Brief Cent Stud Health Syst Change 85:1–4

    Google Scholar 

  42. Greenup RA, Rushing CN, Fish LJ, Lane WO, Peppercorn JM, Bellavance E et al (2019) Perspectives on the costs of cancer care: a survey of the American Society of Breast Surgeons. Ann Surg Oncol 26(10):3141–3151

    Article  PubMed  PubMed Central  Google Scholar 

  43. Schrag D, Hanger M (2007) Medical oncologists’ views on communicating with patients about chemotherapy costs: a pilot survey. J Clin Oncol 25(2):233–237

    Article  PubMed  Google Scholar 

  44. Agarwal A, Livingstone A, Karikios DJ, Stockler MR, Beale PJ, Morton RL (2021) Physician-patient communication of costs and financial burden of cancer and its treatment: a systematic review of clinical guidelines. BMC Cancer 21(1):1036

    Article  PubMed  PubMed Central  Google Scholar 

  45. Shih YT, Chien CR (2017) A review of cost communication in oncology: patient attitude, provider acceptance, and outcome assessment. Cancer 123(6):928–939

    Article  PubMed  Google Scholar 

  46. Hofstatter EW (2010) Understanding patient perspectives on communication about the cost of cancer care: a review of the literature. J Oncol Pract 6(4):188–192

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This work was supported by Natural Science Foundation of China project (72004034) and China Medical Board Open Competition Program (20–371).

Author information

Authors and Affiliations

  1. School of Nursing, Fudan University, Shanghai, China

    Yi Kuang, Tingting Zhang, Yan Ma, Zheng Zhu & Weijie Xing

  2. Fudan University Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China

    Zheng Zhu & Weijie Xing

  3. The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China

    Winnie K. W. So

Authors
  1. Yi Kuang
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  2. Tingting Zhang
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  3. Yan Ma
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  4. Zheng Zhu
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  6. Weijie Xing
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Contributions

Study design: W.X.; data collection and appraisal: Y.K., T.Z., Y.M.; data analysis: Y.K., T.Z., Y.M., W.X.; study supervision: W.X.; manuscript writing: Y.K., T.Z., Y.M.; critical revisions: Y.K., W.X., Z.Z., W.S. All authors revised and accepted the final draft.

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Correspondence to Weijie Xing.

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Kuang, Y., Zhang, T., Ma, Y. et al. Communication of costs and financial burdens between cancer patients and healthcare providers: a qualitative systematic review and meta-synthesis. Support Care Cancer 31, 192 (2023). https://doi.org/10.1007/s00520-023-07647-0

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