Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Support Care Cancer. 2021 Aug;29(8):4835-4845. doi: 10.1007/s00520-021-05984-6. Epub 2021 Feb 5.
Financial toxicity describes the financial burden imposed onto patients by a cancer diagnosis and is a growing concern. Many clinicians do not currently address financial toxicity despite patients' desire for them to do so. Current literature explores physicians' perspectives but does not clearly define an actionable role clinicians can take to address financial toxicity. We sought to fill this gap by first assessing clinicians' perspective on their role in alleviating financial toxicity at our institution. We subsequently aimed to identify current barriers to mitigating financial toxicity and to garner feedback on clinician-oriented interventions to address this growing problem.
We developed an 18-item electronic, anonymous survey through Redcap. We invited all oncology clinicians including attending physicians, advance practice providers, and trainees at our institution to participate.
A total of 72 clinicians (30%) completed the survey. The majority agreed that clinicians have a role in addressing cost. The top three barriers to discussing cost with patients were knowledge of out of pocket costs, time, and awareness of resources. Less than half of respondents used an existing comparative cost tool to incorporate cost consciousness into treatment decisions. The most desired intervention was an institutional resource guide. In open-ended comments, the most common barrier described was transparency of out of pocket costs, and the most common solution proposed was a multi-disciplinary approach to addressing financial concerns patient face.
Improving price transparency, incorporating existing resources into clinical practice, and streamlining multi-disciplinary support may help overcome barriers to addressing financial toxicity.
财务毒性描述了癌症诊断给患者带来的经济负担,这是一个日益严重的问题。尽管患者希望医生能够解决这个问题,但许多临床医生目前并没有解决财务毒性问题。现有文献探讨了医生的观点,但并没有明确界定临床医生可以采取哪些行动来解决财务毒性问题。我们试图通过首先评估我们机构的临床医生在减轻财务毒性方面的作用来填补这一空白。我们随后旨在确定减轻财务毒性的当前障碍,并就解决这一日益严重的问题的以临床医生为导向的干预措施征求反馈意见。
我们通过 Redcap 开发了一个包含 18 个问题的电子匿名调查。我们邀请了我们机构的所有肿瘤临床医生,包括主治医生、高级实践提供者和受训者参与。
共有 72 名临床医生(30%)完成了调查。大多数人认为临床医生在解决成本问题方面发挥了作用。与患者讨论成本的前三大障碍是对自付费用的了解、时间和对资源的认识。不到一半的受访者使用现有的成本比较工具将成本意识纳入治疗决策。最需要的干预措施是机构资源指南。在开放性评论中,描述最多的障碍是自付费用的透明度,提出的最常见的解决方案是多学科方法来解决患者面临的财务问题。
提高价格透明度,将现有资源纳入临床实践,以及简化多学科支持,可能有助于克服解决财务毒性问题的障碍。