Patient Perspectives on Surgical Cost-of-Care Conversations

The first-ever virtual American College of Surgeons Clinical Congress convened Oct. 3-7, 2020. Here, General Surgery News presents highlights from the scientific forum

Surgical patients prefer a face-to-face discussion about the cost of care before their surgery, but some do not want to have these conversations with their surgeons, according to a small study.

Seventeen patients with head and neck cancer, a population uniquely vulnerable to experiencing financial toxicity related to cancer treatment, completed a survey and semi-structured interviews with researchers over a period of five to 14 months after their surgery. They also answered questions about financial distress related to cancer care using the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy tool.

All participants were patients at the Vanderbilt Bill Wilkerson Center, in Nashville, Tenn. They had an average age of 62.9 years (range, 41-90 years), 65% were of male gender, and 88% were white. Forty-seven percent of the patients had an income of less than $50,000 per year. Overall, seven patients had private insurance, seven had Medicare insurance, and three had Medicaid or were uninsured.

The results showed that patients enrolled in Medicaid or who were uninsured experienced the greatest financial toxicity. More than other patients, they wanted financial information earlier in their treatment course, including a breakdown of full surgical costs. “The conversation needs to be had in case somebody needs to save, borrow,” one participant said.

Across all groups, patients preferred discussing costs before treatment, noting that it was inappropriate to avoid discussion of finances. They had mixed opinions about surgeons raising the topic; most preferred to discuss finances with insurance representatives and hospital-employed financial advisors.

In these conversations, patients value transparency, empathy, and the separation of costs and care most highly, said Thomas Day, a medical student at Vanderbilt University School of Medicine, and a study author.

“We can see that there’s no formula for success for discussing finances. Rather, patients value the empathetic delivery of information more than specific times, personnel or types of information to disclose.”

Surgeons and other health care providers should consider patients’ insurance status and financial burden during these conversations, as they may influence preferences, he said.

“If possible, an ideal approach to cost-of-care conversations may be letting patients know that you are aware that cost can be a significant concern for many people and that you can refer them to a financial counselor for more assistance.”

The American College of Physicians and the National Patient Advocate Foundation have published guides to help physicians with cost-of-care conversations.

Source: General Surgery News. By Christina Frangou

Support families fighting financial toxicity of cancer – here