Table 2.

Summary of Articles that Reported Physicians' Attitude toward Cost Communications

Author (year), Country	Population and Characteristics	Site	Sample Size	Willingness to Discuss Costs, %	Costs Discussed, %	Notes
Berry et al (2010),12 USA and Canada Neumann et al (2010),9 USA	- medical oncologists - mean years of practice: 23.8 [USA], 23.2 [Canada]	National organizations, ASCO in USA and various medical societies in Canada	941 787 [US] 154 [Canada]	Not asked	43% [USA] 48% [Canada] always or frequently discuss costs of new cancer treatments	- Mail survey for US oncologists, mail or web-based survey for Canadian oncologists - 84% US, 80% Canada: OOP costs affects treatment recommendation - 67% US, 52% Canada: pts should have access to effective cancer drugs regardless of costs - Neumann et al reported the US portion of this study
Henrikson et al (2014),21 USA	- physicians and physician assistants at oncology clinics - 15.5 mean yrs in practice	a nonprofit integrated healthcare system	11	Not asked	5%- 66% frequency of cost discussions	- semi-structured telephone interview - source of cost data: colleagues most common, >25% from pts - >90% cost information should be readily available
Kelly et al (2015),17 USA	- university faculty (oncologists) specialized in treating breast, lung, or colorectal cancer	single institution	18	28% felt comfortable	6% frequently, 17% sometimes, 55% a little, 22% never	- participating providers helped identify eligible patients to assess ratings of cost communications - provided a standard script - showed cost per cycle via web-based eviti Advisor - data collected via interviews
Hunter et al# (2016),16 USA Hunter et al# (2016),15 USA	- oncologists - 89% male, 63% in practice > 10 years	nationwide community - based practices	56 oncologist	Not asked	22% visits contained cost conversations 16% OOP cost 22% cost/coverage+ 24% COI*	- retrospective, mixed-method analysis of transcribed dialogue from 1755 outpatient visits, sampled from a database of audio-recorded clinical encounters - not limited to cancer, also included 36 psychiatrics and 26 rheumatologists - majority of cost conversations were initiated by physicians - second paper focused on different definitions of “costs” to quantify the incidence of cost conversation
Altomere et al (2016),25 USA	- ASCO members - 35% medical oncologist, 35% radiation oncologist, 31% surgeon - 45% academic, 55% community/private practice - 77% male; 76% white	a random sample of ASCO physician members	333	75% physicians' responsibility to discuss OOP costs in treatment decision 53% physicians' responsibility to discuss societal costs	60% addressed costs frequently or always in clinic 6% never discussed	- self-administered anonymous electronic survey - 94% always or mostly offered all treatment options regardless of costs - 79% felt patients should choose cheaper option if treatments are equally effective - 36% felt explaining costs to patients was not physicians' responsibility - major barriers: don't know enough about costs of care, lack resources

^#only numbers related to breast cancer was subtracted

⁺cost/coverage: included discussion of patients' OOP costs or insurance coverage

^*COI: cost-of-illness, discussion of financial costs or insurance coverage related to health or healthcare; ASCO: American Society of Clinical Oncology; OOP: out-of-pocket