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Garcia-Bautista A, Kamath C, Ayala N, Behnken E, Giblon RE, Gravholt D, Hernández-Leal MJ, Hidalgo J, Leon Garcia M, Golembiewski EH, Maraboto A, Sivly A, Brito JP. Financial Toxicity in the Clinical Encounter: A Paired Survey of Patient and Clinician Perceptions. Mayo Clin Proc Innov Qual Outcomes 2023; 7:248-255. [PMID: 37359420 PMCID: PMC10285501 DOI: 10.1016/j.mayocpiqo.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
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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Affiliation(s)
- Andrea Garcia-Bautista
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Celia Kamath
- Robert D and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Nicolas Ayala
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Emma Behnken
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Rachel E Giblon
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Derek Gravholt
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - María José Hernández-Leal
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Pamplona, Spain
- Medical Sciences, Universidad de La Frontera, Temuco, Chile
- Millenium Nucleus of Sociomedicine (Sociomed), Santiago, Chile
| | - Jessica Hidalgo
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Montserrat Leon Garcia
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
- Iberoamerican Cocharane Center, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | | | - Andrea Maraboto
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Angela Sivly
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Juan P Brito
- Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
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