Shared Decision-Making Among Adolescent and Young Adult Cancer Survivors and Noncancer Adults: Associated Medical Expenditures and Health Care Utilization

摘要

Purpose: Engagement of patients in their care can lead to better health outcomes, especially for adolescent and young adult (AYA) cancer survivors who experience mental and physical illnesses more often than noncancer adults. We examined how patient engagement in care influences health care expenses and use. Methods: AYA cancer survivors (n = 1162) and a comparison group of matched adults with no history of cancer (n = 2954) were identified from the 2011 to 2016 Medical Expenditure Panel Survey (MEPS) data. Medical expenditures and health care utilization associated with shared decision-making (SDM) measured by a self-administered questionnaire adapted from the Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CAHPS-CG) survey were evaluated using multivariable regression models. Results: AYA cancer survivors were more likely to report poor SDM compared with adults with no history of cancer (odds ratio = 1.31, 95% confidence interval [CI]): 1.06 to 1.62). AYA cancer survivors with poor SDM were more likely to report poor mental and physical health compared with AYAs with good SDM. AYA cancer survivors with poor SDM had $3037 (CI: $110 to $7032) in additional annual medical expenses and 4.86 (CI: 2.00 to 8.52) in additional office visits compared with AYA cancer survivors with optimal SDM, even after adjusting for chronic conditions and psychological distress. Conclusion: Our results highlight the substantial economic burden associated with poor SDM in AYA cancer survivors. Our research suggests that interventions to improve SDM in AYA cancer survivors may contribute to patients' positive perception of their health and result in AYAs seeking fewer medical services resulting in lower medical expenses.