WCOE: Different Treatment Options Require Consideration of Patient Preferences, and What We Can Learn from Price Transparency in Veterinary Medicine

In “Breast Cancer Chemotherapy Varies Widely: Study Raises Questions About Early Treatment Choices,” Dr. Elaine Schattner, contributor to Forbes, directs readers to a recently released study that compares the risk of hospitalization between patients with early-stage breast cancer who received different chemotherapy regimens. The study also presented that the six most commonly administered chemotherapy regimens have vastly different side effects. Dr. Schattner challenges readers to critically think about the possible side effects in an effort to demonstrate the difficult decisions that newly diagnosed breast cancer patients face daily.

As Schattner notes, the study “points to the value of patients and doctors having fuller discussions about chemotherapy choices.” As we noted last week, ideally the process of decision-making should be shared, honoring the patient’s goals and values and the physician’s expertise. However, we know that the current cancer care system does not always facilitate these important care coordination conversations, and until it does, tools are needed to assist in the process such as the NCCS Know Yourself Worksheet.

In another article on The Health Care Blog, “Informed Consent 2.0”, Dr. Joseph Smith compares the transparency of the veterinary health care system to the human health care system. Smith begins by noting the similarities in professional values between physicians and veterinarians and their shared requirement to provide the necessary information for decision making. However, he is quick to identify the disparity in information that is given to patients vs. pet owners and asks why veterinarians often disclose important information that physician seldom do? This topic was also covered last week by Matthew Herper in “What I Learned About Health Care When My Cat Died” in Forbes.

As a dog owner myself I have noticed the disparity between the two systems. Unfortunately, my husband and I are all too familiar with the veterinary system, as we fell in love with a breed that is commonly known as one of the most expensive breeds as a result of vet bills. As I write this, my dog is currently at the emergency vet with my husband waiting to be seen for an issue with his dewclaw. I am eagerly watching my phone for the text messages from my husband that will include treatment options outlined by cost, discomfort caused to our dog, outcome, and recovery, which will allow us to make an informed decision on his care. This is a sharp contrast to what I would experience if I needed to be seen by a physician today for an equally minor issue.

While we are aware that comparing the two systems is in many instances like comparing apples and oranges, there are parts of the veterinary system that the human health care system should seek to employ, such as transparency in the cost of care. There is a lot of debate about what should be shared in the cost of cancer care, such as how much, at what level of detail, and whose responsibility. We encourage physicians and policymakers to continue discussing this issue from a patient-centered lens, including patients in the discussion, as there is not a clear consensus within the community. In the fall at the NCCS Cancer Policy Roundtable we will be hosting a panel on communicating cancer care costs to patients in an effort to move forward in this debate.

Lastly, we applaud Amy Berman for writing a beautiful tribute to our friend Jessie Gruman on the Health Affairs Blog.