Cost Transparency in Outpatient Oncology: Barriers and Facilitators
Abstract: Among cancer patients, studies have linked high out-of-pocket (OOP) expenses to medication nonadherence and early discontinuation of therapies. Meanwhile, national provider surveys demonstrate that few oncologists routinely discuss the cost of care with their patients.
The cultural and systemic barriers to communication about costs in oncology are poorly understood. Using a mixed-methods design including interviews and quantitative survey methods, we will assess barriers to and facilitators of cost transparency from both provider and patient perspectives. This study will focus on those cancer patients who are prescribed targeted IV and oral anti-cancer agents, who comprise a population with high OOP financial risk. We will use these data to develop an intervention to facilitate provider-patient communication about the cost implications of cancer therapies.
Using themes identified in the qualitative interview phase, which is currently underway, we will develop and administer quantitative survey instruments which will measure the association between cost transparency outcomes and identified barriers and facilitators. The belief that provider-initiated cost transparency can mitigate the financial and medical harm to patients that results from high out-of-pocket costs underlies our program of research. This project constitutes an important initial step toward the implementation of an ethical, feasible framework for cost transparency in the outpatient oncology setting.