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Abstract：
OBJECTIVE: To understand the impact of cost conversations on the following decision-making outcomes: patients\' knowledge about their conditions and treatment options, decisional conflict, and patient involvement.
METHODS: In 2020 we performed a secondary analysis of a randomly selected set of 220 video recordings of clinical encounters from trials run between 2007 and 2015. Videos were obtained from eight practice-based randomized trials and one pre-post-prospective study comparing care with and without shared decision-making (SDM) tools.
RESULTS: The majority of trial participants were female (61%) and White (86%), with a mean age of 56, some college education (68%), and an income greater than or equal to $40,000 per year (75%), and who did not participate in an encounter aided by an SDM tool (52%). Cost conversations occurred in 106 encounters (48%). In encounters with SDM tools, having a cost conversation lead to lower uncertainty scores (2.1 vs 2.6, P=.02), and higher knowledge (0.7 vs 0.6, P=.04) and patient involvement scores (20 vs 15.7, P=.009) than in encounters using SDM tools where cost conversations did not occur. In a multivariate model, we found slightly worse decisional conflict scores when patients started cost conversations as opposed to when the clinicians started cost conversations. Furthermore, we found higher levels of knowledge when conversations included indirect versus direct cost issues.
CONCLUSIONS: Cost conversations have a minimal but favorable impact on decision-making outcomes in clinical encounters, particularly when they occurred in encounters aided by an SDM tool that raises cost as an issue.
METHODS: In 2020 we performed a secondary analysis of a randomly selected set of 220 video recordings of clinical encounters from trials run between 2007 and 2015. Videos were obtained from eight practice-based randomized trials and one pre-post-prospective study comparing care with and without shared decision-making (SDM) tools.
RESULTS: The majority of trial participants were female (61%) and White (86%), with a mean age of 56, some college education (68%), and an income greater than or equal to $40,000 per year (75%), and who did not participate in an encounter aided by an SDM tool (52%). Cost conversations occurred in 106 encounters (48%). In encounters with SDM tools, having a cost conversation lead to lower uncertainty scores (2.1 vs 2.6, P=.02), and higher knowledge (0.7 vs 0.6, P=.04) and patient involvement scores (20 vs 15.7, P=.009) than in encounters using SDM tools where cost conversations did not occur. In a multivariate model, we found slightly worse decisional conflict scores when patients started cost conversations as opposed to when the clinicians started cost conversations. Furthermore, we found higher levels of knowledge when conversations included indirect versus direct cost issues.
CONCLUSIONS: Cost conversations have a minimal but favorable impact on decision-making outcomes in clinical encounters, particularly when they occurred in encounters aided by an SDM tool that raises cost as an issue.
摘要：
目的：了解成本对话对以下决策结果的影响：患者对病情和治疗方案的了解，决策冲突，和患者参与。
方法：2020年，我们对2007年至2015年间进行的临床试验中随机选择的220个临床视频记录进行了二次分析。视频来自8项基于实践的随机试验和一项前瞻性研究，比较有和没有共享决策（SDM）工具的护理。
结果：大多数试验参与者是女性（61%）和白人（86%）。平均年龄56岁，受过大学教育（68%），以及每年大于或等于40,000美元(75%)的收入，以及未参与SDM工具辅助的相遇者(52%)。在106次相遇中发生了成本对话（48％）。在遇到SDM工具时，进行成本对话会导致较低的不确定性得分(2.1vs2.6，P=0.02)，与使用未发生成本对话的SDM工具的情况相比，知识（0.7vs0.6，P=.04）和患者参与得分（20vs15.7，P=.009）更高。在多变量模型中，我们发现,当患者开始进行成本对话时,与临床医师开始进行成本对话时相比,决策冲突评分稍差.此外，当对话包括间接成本问题和直接成本问题时,我们发现知识水平较高.
结论：成本对话对临床中的决策结果影响最小，但有利，特别是当它们在SDM工具的帮助下发生时，这会导致成本问题。
方法：2020年，我们对2007年至2015年间进行的临床试验中随机选择的220个临床视频记录进行了二次分析。视频来自8项基于实践的随机试验和一项前瞻性研究，比较有和没有共享决策（SDM）工具的护理。
结果：大多数试验参与者是女性（61%）和白人（86%）。平均年龄56岁，受过大学教育（68%），以及每年大于或等于40,000美元(75%)的收入，以及未参与SDM工具辅助的相遇者(52%)。在106次相遇中发生了成本对话（48％）。在遇到SDM工具时，进行成本对话会导致较低的不确定性得分(2.1vs2.6，P=0.02)，与使用未发生成本对话的SDM工具的情况相比，知识（0.7vs0.6，P=.04）和患者参与得分（20vs15.7，P=.009）更高。在多变量模型中，我们发现,当患者开始进行成本对话时,与临床医师开始进行成本对话时相比,决策冲突评分稍差.此外，当对话包括间接成本问题和直接成本问题时,我们发现知识水平较高.
结论：成本对话对临床中的决策结果影响最小，但有利，特别是当它们在SDM工具的帮助下发生时，这会导致成本问题。
