Not all cost conversations are the same: An exploration of potential value in cost conversations during Atrial fibrillation treatment decision making.
Celia C Kamath, Nataly R Espinoza Suarez, Sebastian Vallejo and 3 others
PMID 39032442WHAT IT FOUND
Two-way cost talks about insurance, lifestyle and future costs appeared to help AF patients discover their personalized cost burden; one-way cost readings left patients passive.
The study did not test whether this improved choices or adherence.
Key findings
01Cost conversations varied in content: informational, empathic and relational, and solution-based.
02One-way clinician monologues often did not elicit patient input about insurance, preferences, or reactions; bi-directional exchanges involved patients sharing insurance knowledge, preferences, and cost-reduction ideas.
03Rich content and active bi-directional information exchange facilitated personalized cost burden discovery.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study only described AF cost conversations, so it may not apply to conditions with different cost gaps or decision-making. It was qualitative; it did not test whether any conversation style improved medication choice, adherence, or outcomes. The parent trial reported that cost discussions did not change anticoagulation treatment choice. Participants were mostly male (60.7%) and white (89%), with mean age 72 years, and 79% were already on anticoagulant therapy. Only encounters where patients and clinicians consented to recording were analysed; the paper says 10% were not willing. Transcripts were truncated, so earlier or surrounding cost discussions may have been missed.
The easy way to misread this
Do not conclude that cost conversations improve medication choice or adherence. This qualitative study described what was said and how it was said; it did not test outcomes, and the parent trial reported cost discussions did not change anticoagulation treatment choice.