Working toward evidence-based guidelines for cost-of-care conversations between patients and physicians: A systematic review of the literature

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13 Scopus citations

Abstract

Rationale: As healthcare costs continue to rise, so does the importance of having cost-of-care conversations during medical office visits, especially for patients from vulnerable populations and patients with high-cost illnesses such as cancer. Such conversations remain relatively rare, however, even though physicians and patients say they want to have them. Furthermore, there is a lack of evidence-based guidelines for encouraging cost conversations and improving their quality. Objective: The purpose of this project was to conduct a systematic review of the cost-of-care conversations literature, focusing on empirical studies to characterize the state of the literature and provide a foundation for developing evidence-based guidelines for these important conversations. Method: We searched seven electronic databases and identified an initial list of 1,986 records, 54 of which met inclusion criteria. We reviewed those articles to identify study purpose, use of theory, conceptual and operational definitions of cost conversations, sample characteristics, research methods, variables relevant to cost conversations, and relevant study findings. Results: Results revealed that this literature (a) consists overwhelmingly of cross-sectional survey research set in the United States, (b) defines cost conversations chiefly as those focused on healthcare or medication costs (either in general or out-of-pocket), (c) is focused primarily on establishing incidence/frequency of cost conversations but also considers patient/provider desire for, attitudes/beliefs toward, and perceived barriers to cost conversations, and (d) lacks theoretical guidance. There were very few findings that could provide actionable evidence to guide quality conversations about reducing cost of care. We offer observations and recommendations for the next steps in cost conversations research so that patients and physicians can work together to promote quality care at affordable costs.

Original languageEnglish
Article number113084
JournalSocial Science and Medicine
Volume258
DOIs
StatePublished - Aug 2020

Bibliographical note

Funding Information:
This research was supported in part by two Research and Creative Activities Program grants from the University of Kentucky's Office of the Vice President for Research. The funding source had no involvement in any aspect of this systematic review, in the writing of this manuscript, or in the decision to submit it for publication.

Funding Information:
This research was supported in part by two Research and Creative Activities Program grants from the University of Kentucky ’s Office of the Vice President for Research. The funding source had no involvement in any aspect of this systematic review, in the writing of this manuscript, or in the decision to submit it for publication.

Publisher Copyright:
© 2020 Elsevier Ltd

Keywords

  • Best practices
  • Cost conversations
  • Healthcare costs
  • Patient-physician communication

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science

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