Abstract：
OBJECTIVE: To explore how costs of care are discussed in real clinical encounters and what humanistic elements support them.
METHODS: A qualitative thematic analysis of 41 purposively selected transcripts of video-recorded clinical encounters from trials run between 2007 and 2015. Videos were obtained from a corpus of 220 randomly selected videos from 8 practice-based randomized trials and 1 pre-post prospective study comparing care with and without shared decision making (SDM) tools.
RESULTS: Our qualitative analysis identified two major themes: the first, Space Needed for Cost Conversations, describes patients\' needs regarding their financial capacity. The second, Caring Responses, describes humanistic elements that patients and clinicians can bring to clinical encounters to include good quality cost conversations.
CONCLUSIONS: Our findings suggest that strengthening patient-clinician human connections, focusing on imbalances between patient resources and burdens, and providing space to allow potentially unexpected cost discussions to emerge may best support high quality cost conversations and tailored care plans.
CONCLUSIONS: We recommend clinicians consider 4 aspects of communication, represented by the mnemonic ABLE: Ask questions, Be kind and acknowledge emotions, Listen for indirect signals and (discuss with) Every patient. Future research should evaluate the practicality of these recommendations, along with system-level improvements to support implementation of our recommendations.
METHODS: A qualitative thematic analysis of 41 purposively selected transcripts of video-recorded clinical encounters from trials run between 2007 and 2015. Videos were obtained from a corpus of 220 randomly selected videos from 8 practice-based randomized trials and 1 pre-post prospective study comparing care with and without shared decision making (SDM) tools.
RESULTS: Our qualitative analysis identified two major themes: the first, Space Needed for Cost Conversations, describes patients\' needs regarding their financial capacity. The second, Caring Responses, describes humanistic elements that patients and clinicians can bring to clinical encounters to include good quality cost conversations.
CONCLUSIONS: Our findings suggest that strengthening patient-clinician human connections, focusing on imbalances between patient resources and burdens, and providing space to allow potentially unexpected cost discussions to emerge may best support high quality cost conversations and tailored care plans.
CONCLUSIONS: We recommend clinicians consider 4 aspects of communication, represented by the mnemonic ABLE: Ask questions, Be kind and acknowledge emotions, Listen for indirect signals and (discuss with) Every patient. Future research should evaluate the practicality of these recommendations, along with system-level improvements to support implementation of our recommendations.
摘要：
目的：探讨如何在实际临床中讨论护理成本，以及哪些人文因素支持这些成本。
方法：对2007年至2015年间进行的试验中41个有目的地选择的视频记录临床遭遇的转录本进行了定性主题分析。视频是从来自8项基于实践的随机试验和1项前瞻性研究的220个随机选择的视频语料库中获得的，这些研究比较了有和没有共享决策（SDM）工具的护理。
结果：我们的定性分析确定了两个主要主题：成本对话需要的空间，描述患者对其经济能力的需求。第二个,关怀回应，描述了患者和临床医生可以带来的人文元素，包括高质量的成本对话。
结论：我们的研究结果表明，加强患者与临床医生的人际关系，关注病人资源和负担之间的不平衡，并提供空间以允许潜在的意外成本讨论出现可能最好地支持高质量的成本对话和量身定制的护理计划。
结论：我们建议临床医生考虑四个方面的沟通，由助记符ABLE表示：提问，要善良，承认情绪，倾听间接信号，并（与）每个患者讨论。未来的研究应该评估这些建议的实用性，以及系统级的改进，以支持我们建议的实施。
方法：对2007年至2015年间进行的试验中41个有目的地选择的视频记录临床遭遇的转录本进行了定性主题分析。视频是从来自8项基于实践的随机试验和1项前瞻性研究的220个随机选择的视频语料库中获得的，这些研究比较了有和没有共享决策（SDM）工具的护理。
结果：我们的定性分析确定了两个主要主题：成本对话需要的空间，描述患者对其经济能力的需求。第二个,关怀回应，描述了患者和临床医生可以带来的人文元素，包括高质量的成本对话。
结论：我们的研究结果表明，加强患者与临床医生的人际关系，关注病人资源和负担之间的不平衡，并提供空间以允许潜在的意外成本讨论出现可能最好地支持高质量的成本对话和量身定制的护理计划。
结论：我们建议临床医生考虑四个方面的沟通，由助记符ABLE表示：提问，要善良，承认情绪，倾听间接信号，并（与）每个患者讨论。未来的研究应该评估这些建议的实用性，以及系统级的改进，以支持我们建议的实施。
