Nora Henrikson, PhD, talks about working to find effective ways for clinical teams to discuss cost with cancer patients. She is an assistant investigator at Kaiser Permanente Washington Health Research Institute in Seattle. At Kaiser Permanente Washington and Northwest, with Robert Wood Johnson Foundation funding, she and her colleagues explored how to help clinical teams to do that. The Annals of Internal Medicine published their study, titled “Workflow Requirements for Cost-of-Care Conversations in Outpatient Settings Providing Oncology or Primary Care: A Qualitative, Human-Centered Design Study.”
You can learn more about Dr. Henrikson and her research here: kpwashingtonresearch.org/news-and-events/recent-news/news-2019/why-does-nora-henrikson-study-patients-cost-treatment/
Full transcript. Closed Captions coming soon.
I started my career as a director of a patient indication program in a cancer center. And I saw first-hand the financial distress and the financial worries that our patients experienced and that really, really affected their lives. So it really motivates me to think that we might be able to help people who are going through a difficult time.
We know that patients who experience financial distress or financial worry actually also more likely experienced a worse quality of life as part of their healthcare. In the cancer setting there's also evidence to suggest that people who experience more material financial hardship something like debt or bankruptcy that they actually are at risk for higher mortality from cancer.
So there's a really strong argument.
There's a strong rational for wanting to study this and see if we could help the clinical teams find ways to have these conversations with patients more effectively.
We found that it was a big ask for the clinicians and teams to be able to just do that without some more attention to work flow.
First we identified the types of questions that, that patients might have about cost
We took that, all that data back and created these storyboards that show this sort of ideal patient experiences based on what we were finding
Show storyboard 1. And so first you have a question about cost--what it might really affect the treatment decision making. So in that situation the doctor would really need to know the cost of what they were ordering and what that was going to be for the patient and they might even want to compare it to a cost of doing the same treatment in another way.
Show storyboard 2. Another way, a second way is people who just want – they've already made their decision about their care and they don’t have questions about the treatment itself, they are totally on board with what they're going to do but they just want to anticipate and understand what their cost are going to be throughout the course of that treatment .
Show storyboard 3. And then the third way that we think patients have cost concerns or cost questions that are relevant to the clinical setting, is when somebody is really in financial distress immediately when they come into the clinic.
And sometimes those patients have very specific needs and need referral to services that we can help provide.
We actually went and put those [storyboards] in front of patients and worked with patients directly and asked them, we walked them through each scenario and each journey and asked them to comment and ask us how useful they thought each one was and what could be changed around that. So that was something that helped us really get a very rich understanding very quickly during the study.
What we found in this study was that, understanding those different types of questions
really was associated with different types of data and resources that you would need to give to a patient or a team to serve that patient according to those types.
People had pretty strongly felt not surprisingly that they didn’t really want to be asked in the waiting room about whether they had cost concerns but they had or did not have concerns about having any cost concerns noted in the medical record.
There was a wide support for having a doctor have a relatively limited role which as I mentioned is a fairly newish idea.
There was wide support in the patients that we talked to for a real team based approach.