title: The neglected topic: presentation of cost information in patient decision AIDS.
abstract: Costs are an important component of patients' decision making, but a comparatively underemphasized aspect of formal shared decision making. We hypothesized that decision aids also avoid discussion of costs, despite their being tools designed to facilitate shared decision making about patient-centered outcomes. We sought to define the frequency of cost-related information and identify the common modes of presenting cost and cost-related information in the 290 decision aids catalogued in the Ottawa Hospital Research Institute's Decision Aid Library Inventory (DALI) system. We found that 56% (n = 161) of the decision aids mentioned cost in some way, but only 13% (n = 37) gave a specific price or range of prices. We identified 9 different ways in which cost was mentioned. The most common approach was as a "pro" of one of the treatment options (e.g., "you avoid the cost of medication"). Of the 37 decision aids that gave specific prices or ranges of prices for treatment options, only 2 were about surgery decisions despite the fact that surgery decision aids were the most common. Our findings suggest that presentation of cost information in decision aids is highly variable. Evidence-based guidelines should be developed by the International Patient Decision Aid Standards (IPDAS) Collaboration.
authors.affiliation: Department of Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas (JSB-B)
authors.forename: J S
authors.initials: JS
authors.lastname: Blumenthal-Barby
authors.affiliation: Department of Organizational Behavior, INSEAD, Fontainebleau, France (ER)
authors.forename: Emily
authors.initials: E
authors.lastname: Robinson
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (SBC, RJV)
authors.forename: Scott B
authors.initials: SB
authors.lastname: Cantor
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas (ADN)
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas (HVR).
authors.forename: Heidi Voelker
authors.initials: HV
authors.lastname: Russell
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (SBC, RJV)
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Volk
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000191:economics* / Q000628:therapy; D017281:Cost of Illness; D016208:Databases, Factual; D003657:Decision Making; D003661:Decision Support Techniques; D006761:Hospitals; D006801:Humans; D009864:Ontario; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation; D014481:United States; D016270:United States Agency for Healthcare Research and Quality
keywords: consumer issues; cost; decision aids; decision making; ethical issues; health economics