Shih Ya-Chen Tina, Chien Chun-Ru
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.
Cancer. 2017 May 15;123(6):928-939. doi: 10.1002/cncr.30423. Epub 2016 Nov 28.
The American Society of Clinical Oncology released its first guidance statement on the cost of cancer care in August 2009, affirming that patient-physician cost communication is a critical component of high-quality care. This forward-thinking recommendation has grown increasingly important in oncology practice today as the high costs of cancer care impose tremendous financial burden to patients, their families, and the health care system. For the current review, a literature search was conducted using the PubMed and Web of Science databases to identify articles that covered 3 topics related to patient-physician cost communication: patient attitude, physician acceptance, and the associated outcomes; and 15 articles from 12 distinct studies were identified. Although most articles that addressed patient attitude suggested that cost communication is desired by >50% of patients in the respective study cohorts, only <33% of patients in those studies had actually discussed costs with their physicians. The literature on physician acceptance indicated that, although 75% of physicians considered discussions of out-of-pocket costs with patients their responsibility, <30% felt comfortable with such communication. When asked about whether cost communication actually took place in their practice, percentages reported by physicians varied widely from <10% to >60%. The data suggested that cost communication was associated with improved patient satisfaction, lower out-of-pocket expenses, and a higher likelihood of medication nonadherence; none of the studies established causality. Both patients and physicians expressed a strong need for accurate, accessible, and transparent information about the cost of cancer care. Cancer 2017;123:928-39. © 2016 American Cancer Society.
美国临床肿瘤学会于2009年8月发布了首份关于癌症治疗费用的指导声明，确认患者与医生之间的费用沟通是高质量医疗的关键组成部分。随着癌症治疗的高昂费用给患者、其家庭和医疗保健系统带来巨大经济负担，这一具有前瞻性的建议在当今肿瘤学实践中变得越来越重要。在本次综述中，使用PubMed和科学网数据库进行了文献检索，以识别涵盖与患者-医生费用沟通相关的3个主题的文章：患者态度、医生接受度及相关结果；共识别出12项不同研究中的15篇文章。尽管大多数涉及患者态度的文章表明，在各自研究队列中超过50%的患者希望进行费用沟通，但在这些研究中只有不到33%的患者实际与医生讨论过费用。关于医生接受度的文献表明，尽管75%的医生认为与患者讨论自付费用是他们的责任，但只有不到30%的医生对这种沟通感到自在。当被问及费用沟通在他们的实践中是否实际发生时，医生报告的比例差异很大，从不到10%到超过60%不等。数据表明，费用沟通与患者满意度提高、自付费用降低以及药物治疗依从性降低的可能性相关；没有一项研究确定因果关系。患者和医生都强烈表示需要有关癌症治疗费用的准确、可获取和透明的信息。《癌症》2017年；123:928 - 39。©2016美国癌症协会。
