背景:在不施加与其抗癌治疗相关的重大经济负担的情况下优化癌症患者的护理变得越来越困难。美国临床肿瘤学会(ASCO)建议临床医生与患者讨论癌症治疗的成本,以加强共同决策。我们寻求信息来指导肿瘤学家与患者讨论这些费用。
方法:我们搜索了Medline,2009年1月至2019年6月1日的EMBASE和临床实践指南数据库,以提供有关讨论护理成本和经济负担的建议。使用AGREE-II仪器评估指南质量。
结果:27个指南符合我们的资格标准,其中16人来自ASCO(59%)。27个指南中有21个(78%)包括关于开药时讨论或考虑治疗费用的建议,有关于实际成本的信息在四个(15%)。81%(22/27)的指南中描述了对财务负担或财务毒性风险的认识。然而,只有9条指导方针(33%)包含了有关财政负担管理的信息。
结论:目前的临床实践指南几乎没有信息指导医患讨论抗癌治疗的费用和经济负担的管理。这限制了患者控制治疗费用的能力,并为医疗团队减少财政负担的发生率和严重程度。目前的指南建议临床医生了解价格波动和高治疗成本。建议临床医生探索成本问题并解决财务问题,尤其是高危人群。未来的指导方针应包括关于促进成本透明度讨论的建议,提供成本信息和资源。
BACKGROUND: Optimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. The American Society of Clinical Oncology (ASCO) has recommended clinicians discuss costs of cancer care with patients to enhance shared decision-making. We sought information to guide oncologists\' discussions with patients about these costs.
METHODS: We searched Medline, EMBASE and clinical practice
guideline databases from January 2009 to 1 June 2019 for recommendations about discussing the costs of care and financial burden.
Guideline quality was assessed with the AGREE-II instrument.
RESULTS: Twenty-seven
guidelines met our eligibility criteria, including 16 from ASCO (59%). 21 of 27 (78%)
guidelines included recommendations about discussion or consideration of treatment costs when prescribing, with information about actual costs in four (15%). Recognition of the risk of financial burden or financial toxicity was described in 81% (22/27) of guidelines. However, only nine
guidelines (33%) included information about managing the financial burden.
CONCLUSIONS: Current clinical practice guidelines have little information to guide physician-patient discussions about costs of anticancer treatment and management of financial burden. This limits patients\' ability to control costs of treatment, and for the healthcare team to reduce the incidence and severity of financial burden. Current guidelines recommend clinician awareness of price variability and high costs of treatment. Clinicians are recommended to explore cost concerns and address financial worries, especially in high risk groups. Future guidelines should include advice on facilitating cost transparency discussions, with provision of cost information and resources.