Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 109 Observatory, Ann Arbor, MI, 48109, USA.
Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Breast Cancer Res Treat. 2019 Jan;173(1):31-36. doi: 10.1007/s10549-018-4976-7. Epub 2018 Sep 26.
High costs of cancer care place considerable burden on patients and society. Despite increasing recognition that providers should play a role in reducing care costs, how physicians across cancer specialties differ in their cost-consciousness has not been reported. We examined cost-consciousness regarding breast cancer care among medical oncologists, surgeons, and radiation oncologists.
We identified 514 cancer surgeons, 504 medical oncologists, and 251 radiation oncologists by patient report through the iCanCare study. iCanCare identified newly diagnosed women with breast cancer through the Surveillance, Epidemiology, and End Results (SEER) registries of Georgia and Los Angeles. We queried providers on three dimensions of cost-consciousness: (1) perceived importance of cost saving for society, patients, practice, and payers; (2) awareness of patient out-of-pocket expenses; and (3) discussion of financial burden.
We received responses from 376 surgeons (73%), 304 medical oncologists (60%), and 169 radiation oncologists (67%). Overall levels of cost-consciousness were moderate, with scores ranging from 2.5 to 3.0 out of 5. After adjusting for covariates, surgeons had the lowest scores on all three cost-consciousness measures; medical oncologists had the highest scores. Pairwise contrasts showed surgeons had significantly lower scores than medical oncologists for all three measures and significantly lower scores than radiation oncologists for two of the three cost-consciousness variables: importance of cost saving and discussion of financial burden.
How cost-consciousness impacts medical decision-making across specialty and how policy, structural, and behavioral interventions might sensitize providers regarding cost-related matters merit further examination.
癌症治疗费用高昂给患者和社会带来了相当大的负担。尽管越来越多的人认识到医生应该在降低医疗成本方面发挥作用，但不同癌症专业的医生在成本意识方面的差异尚未得到报道。我们研究了肿瘤内科医生、外科医生和放射肿瘤医生在乳腺癌治疗方面的成本意识。
我们通过 iCanCare 研究通过患者报告从佐治亚州和洛杉矶的监测、流行病学和最终结果 (SEER) 登记处确定了 514 名癌症外科医生、504 名肿瘤内科医生和 251 名放射肿瘤医生。我们向提供者询问了成本意识的三个方面：（1）为社会、患者、实践和支付者节省成本的重要性；（2）对患者自付费用的认识；（3）讨论经济负担。
我们收到了 376 名外科医生（73%）、304 名肿瘤内科医生（60%）和 169 名放射肿瘤医生（67%）的回复。总体成本意识水平中等，得分范围为 5 分中的 2.5 至 3.0。在调整了协变量后，外科医生在所有三个成本意识测量方面的得分最低；肿瘤内科医生的得分最高。两两比较显示，外科医生在所有三个方面的得分均显著低于肿瘤内科医生，在两个成本意识变量（节省成本的重要性和经济负担的讨论）方面的得分也显著低于放射肿瘤医生。
成本意识如何影响跨专业的医疗决策，以及政策、结构和行为干预如何使提供者更加关注成本相关问题，这些都值得进一步研究。
