title: Out-of-pocket expenses and treatment choice for men with prostate cancer.
abstract: OBJECTIVE
  To describe the knowledge of, and attitudes toward, out-of-pocket expenses (OOPE) associated with prostate cancer treatment and the influence of OOPE on the treatment choices of patients with prostate cancer.
  
  
  METHODS
  We undertook a qualitative research study for which we recruited patients with clinically localized prostate cancer. Patients answered a series of open-ended questions during a semistructured interview and completed a questionnaire about the physician's role in discussing OOPE, the burden of OOPE, the effect of OOPE on treatment decisions, and previous knowledge of OOPE.
  
  
  RESULTS
  A total of 41 (26 white and 15 black) eligible patients were enrolled from the urology and radiation oncology practices of the University of Pennsylvania. Qualitative assessment revealed 5 major themes: (a) "my insurance takes care of it"; (b) "health is more important than cost"; (c) "I did not look into it"; (d) "I cannot afford it but would have chosen the same treatment"; and (e) "It is not my doctor's business." Most patients (38 of 41, 93%) reported that they would not have chosen a different treatment even if they had known the actual OOPE of their treatment. Patients who reported feeling burdened by OOPE were socioeconomically heterogeneous, and their treatment choices remained unaffected. Only 2 patients stated they knew "a lot" about the likely OOPE for different prostate cancer treatments before choosing their treatment.
  
  
  CONCLUSIONS
  Among insured patients with prostate cancer treated at a large academic medical center, few had knowledge of OOPE before making treatment choices.
authors.affiliation: Health Policy Management Doctoral Program, Harvard Business School, Boston, Massachusetts, USA.
authors.forename: Olivia S
authors.initials: OS
authors.lastname: Jung
authors.forename: Thomas
authors.initials: T
authors.lastname: Guzzo
authors.forename: David
authors.initials: D
authors.lastname: Lee
authors.forename: Michael
authors.initials: M
authors.lastname: Mehler
authors.forename: John
authors.initials: J
authors.lastname: Christodouleas
authors.forename: Curtiland
authors.initials: C
authors.lastname: Deville
authors.forename: Genevieve
authors.initials: G
authors.lastname: Hollis
authors.forename: Anand
authors.initials: A
authors.lastname: Shah
authors.forename: Neha
authors.initials: N
authors.lastname: Vapiwala
authors.forename: Alan
authors.initials: A
authors.lastname: Wein
authors.forename: Mark
authors.initials: M
authors.lastname: Pauly
authors.forename: Justin E
authors.initials: JE
authors.lastname: Bekelman
mesh_terms: D000328:Adult; D000368:Aged; D001290:Attitude; D002755:Choice Behavior; D017281:Cost of Illness; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D010819:Physician's Role; D011468:Prostatectomy / Q000191:economics; D011471:Prostatic Neoplasms / Q000191:economics* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D036301:Qualitative Research