Dr Yousuf Zafar Explains How to Broach the Topic of Cost With Patients

It is important to have financial discussions early and often with patients and framing the conversation in the right way, said Yousuf Zafar, MD, MHS, of the Duke Cancer Institute and a member of the Association of Community Cancer Centers Financial Advocacy Network Advisory Committee.

Transcript

How do financial advocates or financial navigators integrate into a care team?

Financial advocates play an incredibly important role in this process. A lot of it has to do with bringing to the table a set of knowledge that they can really apply to help patients, to understand what resources are available to them, to help them prepare for costs, and to act as a liaison between the clinician and the patient such that the clinician can really help in terms of making appropriate clinical decisions and the financial advocate can help in assisting the patient afford those treatments.

How should discussions of financial distress and planning be incorporated into a patient’s cancer journey?

I think that affordability discussions should happen early. I’m not completely sure, yet, who should be having that discussion: whether the clinician should have that discussion, or the financial advocate should have the discussion first. But, what I do know is, as a clinician, my responsibility is to make sure that my patient can tolerate their treatment both from a physical perspective and from a financial perspective.

And, so, in my practice, I will often ask patients questions like, “Are you able to afford your treatment?” And if they say, “No,” I then direct them to our financial care counselors. I think that conversation needs to happen not just early, but often.

During financial conversations, are patients open and willing to discuss what they can’t afford?

I think more and more patients understand that cost has to be a part of their decision making if they want to stay on their treatment and be able to afford it. The trick comes in how that conversation is couched.

So for me, I am very careful to let patients understand that I am asking this question not because I’m interested in reimbursement or, even at that moment, not that I’m interested in the overall economic well-being of the health system. But what I’m interested in is being able to help the patient in front of me be able to afford their care. Afford the care that I think is the best for them. And that’s how I couch that discussion, to make it as easy as possible for the patient. To remove all risk of embarrassment or misunderstanding on the part of the patient.