ABLE to support patient financial capacity: A qualitative analysis of cost conversations in clinical encounters. Issue 11 (November 2022)

• Record Type: Journal Article
• Authors: Espinoza Suarez, Nataly R.; LaVecchia, Christina M.; Morrow, Allison S.; Fischer, Karen M.; Kamath, Celia; Boehmer, Kasey R.; Brito, Juan P.
• Is Part Of: Patient education and counseling. Volume 105:Issue 11(2022)
• Page Start: 3249
• Page End: 3258
• Publication Date: 2022-11
• Subjects: Cost conversations -- Healthcare economics -- Clinical encounters -- Patient-clinician communication -- Patient capacity -- Financial capacity; Patient education -- Periodicals; Health counseling -- Periodicals; Health education -- Periodicals; Counseling -- Periodicals; Patient Education -- Periodicals; Éducation des patients -- Périodiques; Counseling -- Périodiques; Éducation sanitaire -- Périodiques; 615.5071
• DOI: 10.1016/j.pec.2022.07.016
• Languages: English
• ISSNs: 0738-3991

Abstract

Abstract: Objective: To explore how costs of care are discussed in real clinical encounters and what humanistic elements support them. Methods: A qualitative thematic analysis of 41 purposively selected transcripts of video-recorded clinical encounters from trials run between 2007 and 2015. Videos were obtained from a corpus of 220 randomly selected videos from 8 practice-based randomized trials and 1 pre–post prospective study comparing care with and without shared decision making (SDM) tools. Results: Our qualitative analysis identified two major themes: the first, Space Needed for Cost Conversations, describes patients' needs regarding their financial capacity. The second, Caring Responses, describes humanistic elements that patients and clinicians can bring to clinical encounters to include good quality cost conversations. Conclusion: Our findings suggest that strengthening patient-clinician human connections, focusing on imbalances between patient resources and burdens, and providing space to allow potentially unexpected cost discussions to emerge may best support high quality cost conversations and tailored care plans. Practice implications: We recommend clinicians consider 4 aspects of communication, represented by the mnemonic ABLE: Ask questions, Be kind and acknowledge emotions, Listen for indirect signals and (discuss with) Every patient. Future research should evaluate the practicality of these recommendations, along with system-level improvements to support implementation of our recommendations. Highlights: Patients need space for cost conversations whether or not they experience financial hardships. Patients are eager to discuss costs and often share indirect signals of financial burdens. High-quality responses to patient needs demonstrate a drive to know why patients face cost issues. Empathic responses to patient burdens made space for broad conversations about care, including costs.