Do discussions of financial burdens decrease long-term financial toxicity in adolescent and young adult cancer survivors?

PURPOSE: This study aims to evaluate the associations between patient-provider cost discussions with patient-reported out-of-pocket (OOP) spending and long-term financial toxicity (FT) among adolescent and young adult (AYA; 15-39 years old) cancer survivors. METHODS: Using a cross-sectional survey, we assessed the themes and quality of patient discussions with providers about financial needs and general survivorship preparation, quantified patients' levels of FT, and evaluated patient-reported OOP spending. We determined the association between cancer treatment cost discussion and FT using multivariable analysis. In a subset of survivors (n = 18), we conducted qualitative interviews and used thematic analysis to characterize responses. RESULTS: Two hundred forty-seven AYA survivors completed the survey at a mean of 7 years post treatment and with a median COST score of 13. 70% of AYA survivors did not recall having any cost discussion about their cancer treatment with a provider. Having any cost discussion with a provider was associated with decreased FT (ß = 3.00; p = 0.02) but not associated with reduced OOP spending (χ2 = 3.77; p = 0.44). In a second adjusted model, with OOP spending included as a covariate, OOP spending was a significant predictor of FT (ß = - 1.40; p = 0.002). Key qualitative themes included survivors' frustration about the lack of communication related to financial issues throughout treatment and in survivorship, feeling unprepared, and reluctance to seek help. CONCLUSION: AYA patients are not fully informed about the costs of cancer care and FT; the dearth of cost discussions between patients and providers may represent a missed opportunity to reduce costs.

So Many Ways to Be Wrong: Completeness and Accuracy in a Prospective Study of OR-to-ICU Handoff Standardization.

BACKGROUND: Studies focused on improving handoffs often measure the quality of information exchange using information completeness without reporting on accuracy. The present investigation aimed to characterize changes in the accuracy of transmitted patient information after standardization of operating room (OR)-to-ICU handoffs. METHODS: Handoffs and Transitions in Critical Care (HATRICC) was a mixed methods study conducted in two US ICUs. From 2014 to 2016, trained observers captured the nature and content of information transmitted during OR-to-ICU handoffs, comparing this to the electronic medical record. Inconsistencies were compared before and after handoff standardization. Semistructured interviews initially conducted for implementation were reanalyzed to contextualize quantitative findings. RESULTS: A total of 160 OR-to-ICU handoffs were observed-63 before and 97 after standardization. Across seven categories of information, including allergies, past surgical history, and IV fluids, two types of inaccuracy were observed: incomplete information (for example, providing only a partial list of allergies) and incorrect information. Before standardization, an average of 3.5 information elements per handoff were incomplete, and 0.11 were incorrect. After standardization, the number of incomplete information elements per handoff decreased to 2.4 (-1.1, p < 0.001), and the number of incorrect items was similar, at 0.16 (p = 0.54). Interviews revealed that the familiarity of a transporting OR provider (for example, surgeon, anesthetist) with the patient's case was considered an important factor affecting information exchange. CONCLUSION: Handoff accuracy improved after standardizing OR-to-ICU handoffs in a two-ICU study. The improvement in accuracy was due to improved completeness rather than a change in the transmission of inaccurate information.