Interventions supporting cost conversations between patients and clinicians: A systematic review

Background and Aim Discussing cost during medical encounters may decrease the financial impact of medical care on patients and align their treatment plans with their financial capacities. We aimed to examine which interventions exist and quantify their effectiveness to support cost conversations. Methods Several databases were queried (Embase; Ovid MEDLINE(R); Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; the Cochrane databases; and Scopus) from their inception until January 31, 2020 using terms such as clinician*, patient*, cost*, and conversation*. Eligibility assessment, data extraction and risk of bias assessment were performed independently and in duplicate. We extracted study setting, design, intervention characteristics and outcomes related to patients, clinicians and quality metrics. Results We identified four studies (1327 patients) meeting our inclusion criteria. All studies were non-randomised and conducted in the United States. Three were performed in a primary care setting and the fourth in an oncology. Two studies used decision aids that included cost information; one used a training session for health care staff about cost conversations, and the other directly delivered information regarding cost conversations to patients. All interventions increased cost-conversation frequency. There was no effect on out-of-pocket costs, satisfaction, medication adherence or understanding of costs of care. Conclusion The body of evidence is small and comprised of studies at high risk of bias. However, an increase in the frequency of cost conversations is consistent. Studies with higher quality are needed to ascertain the effects of these interventions on the acceptability, frequency and quality of cost conversations.

Automated summary

This study aimed to examine the effectiveness of interventions for discussing costs during medical encounters and identified four studies meeting inclusion criteria, with increased frequency of cost conversations observed in all interventions. However, there was no significant effect on patients' out-of-pocket costs, satisfaction, medication adherence, or understanding of costs of care. More high-quality studies are needed to determine the impact of these interventions on the acceptability, frequency, and quality of cost conversations.