Financial Toxicity in the Clinical Encounter: A Paired Survey of Patient and Clinician Perceptions

  1. Garcia-Bautista, Andrea 1
  2. Kamath, Celia 1
  3. Ayala, Nicolas 1
  4. Behnken, Emma 1
  5. Giblon, Rachel E. 6
  6. Gravholt, Derek 1
  7. Hernández-Leal, María José 234
  8. Hidalgo, Jessica 1
  9. Leon Garcia, Montserrat 15
  10. Golembiewski, Elizabeth H. 1
  11. Maraboto, Andrea 1
  12. Sivly, Angela 1
  13. Brito, Juan P. 1
  1. 1 Mayo Clinic
    info

    Mayo Clinic

    Rochester, Estados Unidos

    ROR https://ror.org/02qp3tb03

  2. 2 Universidad de Navarra
    info

    Universidad de Navarra

    Pamplona, España

    ROR https://ror.org/02rxc7m23

  3. 3 Universidad de La Frontera
    info

    Universidad de La Frontera

    Temuco, Chile

    ROR https://ror.org/04v0snf24

  4. 4 Millenium Nucleus of Sociomedicine (Sociomed), Santiago, Chile
  5. 5 Iberoamerican Cocharane Center, Biomedical Research Institute Sant Pau, Barcelona, Spain
  6. 6 University of Toronto
    info

    University of Toronto

    Toronto, Canadá

    ROR https://ror.org/03dbr7087

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Revista:
Mayo Clinic Proceedings: Innovations, Quality & Outcomes

ISSN: 2542-4548

Año de publicación: 2023

Volumen: 7

Número: 4

Páginas: 248-255

Tipo: Artículo

DOI: 10.1016/J.MAYOCPIQO.2023.05.003 GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Mayo Clinic Proceedings: Innovations, Quality & Outcomes

Resumen

Objective: To compare the agreement between patient and clinician perceptions of care-related financial issues. Patients and Methods: We surveyed patient-clinician dyads immediately after an outpatient medical encounter between September 2019 and May 2021. They were asked to separately rate (1-10) patient’s level of difficulty in paying medical bills and the importance of discussing cost issues with that patient during clinical encounters. We calculated agreement between patient-clinician ratings using the intraclass correlation coefficient and used random effects regression models to identify patient predictors of paired score differences in difficulty and importance of ratings. Results: 58 pairs of patients (n=58) and clinicians (n=40) completed the survey. Patient-clinician agreement was poor for both measures, but higher for difficulty in paying medical bills (intraclass correlation coefficient=0.375; 95% CI, 0.13-0.57) than for the importance of discussing cost (−0.051; 95% CI, −0.31 to 0.21). Agreement on difficulty in paying medical bills was not lower in encounters with conversations about the cost of care. In adjusted models, poor patient-clinician agreement on difficulty in paying medical bills was associated with lower patient socioeconomic status and education level, whereas poor agreement on patient-perceived importance of discussing cost was significant for patients who were White, married, reported 1 or more long-term conditions, and had higher education and income levels. Conclusion: Even in encounters where cost conversations occurred, there was poor patient-clinician agreement on ratings of the patient’s difficulty in paying medical bills and perceived importance of discussing cost issues. Clinicians need more training and support in detecting the level of financial burden and tailoring cost conversations to the needs of individual patients.

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