title: Physician Experience and Attitudes Toward Addressing the Cost of Cancer Care.
abstract: OBJECTIVE
  We surveyed US cancer doctors to examine current attitudes toward cost discussions and how they influence decision making and practice management.
  
  
  METHODS
  We conducted a self-administered, anonymous, electronic survey of randomly selected physician ASCO members to evaluate the frequency and nature of cost discussions reported by physicians, attitudes toward discussions of cost in clinics, and potential barriers.
  
  
  RESULTS
  A total of 333 of 2,290 physicians responded (response rate [RR], 15%; adjusted RR after omitting nonpracticing physician ASCO members, 25%), Respondent practice settings were 45% academic and 55% community/private practice. Overall, 60% reported addressing costs frequently/always in clinic, whereas 40% addressed costs rarely/never. The largest reported barrier was lack of resources to guide discussions. Those who reported frequent discussions were significantly more likely to prioritize treatments in terms of cost and believed doctors should explain patient and societal costs. A total of 36%did not believe that doctors should discuss costs with patients. Academic practitioners were significantly less likely to discuss costs (odds ratio [OR], 0.41; P = .001) and felt less prepared for such discussions (OR, 0.492; P = .005) but were more likely to consider costs to the patient (OR, 2.68; P = .02) and society (OR, 1.822; P = .02).
  
  
  CONCLUSIONS
  Although the majority of respondents believe it is important to consider out-of-pocket costs to patients, a substantial proportion do not discuss or consider costs of cancer care. Lack of consensus on the importance of such discussions and uncertainty regarding the optimal timing and content appear to be barriers to addressing costs of care with patients.
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA ivy.altomare@duke.edu.
authors.forename: Ivy
authors.initials: I
authors.lastname: Altomare
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA.
authors.forename: Blair
authors.initials: B
authors.lastname: Irwin
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA.
authors.forename: Syed Yousuf
authors.initials: SY
authors.lastname: Zafar
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Houck
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA.
authors.forename: Bailey
authors.initials: B
authors.lastname: Maloney
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Greenup
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham; North Carolina State University, Raleigh, NC; Massachusetts General Hospital; and Harvard Medical School, Boston, MA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Peppercorn
mesh_terms: D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008495:Medical Oncology; D009369:Neoplasms / Q000191:economics / Q000628:therapy*; D010817:Physician-Patient Relations; D010820:Physicians; D010818:Practice Patterns, Physicians'