Primary Care Physicians’ Strategic Pursuit of Multiple Goals in Cost-of-Care Conversations with Patients
Bibliographic Data
| ID | 21616255 |
|---|---|
| Authors | Allison M Scott (0000-0002-4806-7912, University of Kentucky, corresponding author), Nancy Grant Harrington (0000-0001-5952-4405, University of Kentucky), Emma Spencer (0000-0002-5988-2648, University of Kentucky), Elizabeth A Spencer (University of Kentucky) |
| Year | 2021 |
| Volume | 36 |
| Issue | 8 |
| Pages | 927-939 |
| Publication date | 2021-07-03 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Health Communication (JOURNAL) |
| Journal identifiers | ISSN: 1041-0236 • E-ISSN: 1532-7027 |
| Publisher | Informa UK Limited (PUBLISHER • GB) |
| DOI | 10.1080/10410236.2020.1723051 |
| PMID | 32019346 |
| OpenAlex | W3004553258 |
| Language | EN |
| Citations received | 7 |
| References cited | 34 |
Despite the importance of cost-of-care conversations between physicians and patients, such discussions are not well understood. We used multiple goals theory to examine the specific goals that are salient in these discussions and how physicians pursue these goals. We used qualitative descriptive coding to analyze the verbatim transcripts from in-depth interviews with 36 primary care physicians. Our analysis identified a number of goals that are commonly salient in cost conversations, including task goals (reducing the cost of care, making treatment decisions, and promoting patient adherence), identity goals (reinforcing their professional identity as a “good doctor,” acting as a steward of medical resources, being an advocate for patients, and preventing patient embarrassment), and relational goals (strengthening the physician–patient relationship and mitigating damage to the physician–patient relationship). In addition, participants articulated a number of ways in which these goals compete with each other, making cost conversations challenging. We found that physicians use a common repertoire of rhetorical strategies to manage these goals, including directly addressing cost, avoiding discussion of cost, and falsely reassuring patients about cost concerns. Our analysis revealed that the meaning of the cost conversation explains the connection between physicians’ goals and strategies. Specifically, we found that physicians invoke polysemic meanings of cost conversations to achieve their multiple goals using seemingly contradictory strategies. The results of our analysis have implications for building theory and improving practice
Conversation · Conversation analysis · Embarrassment · Medical education · Political science · Psychotherapist · Public relations · Qualitative research · Rhetorical question · Salient · Sociology · Thematic analysis · Computer Science · Health Systems, Economic Evaluations, Quality of Life · Healthcare cost, quality, practices · Medicine · Nursing · Pharmaceutical industry and healthcare · Psychology · Social Psychology
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| Citations per year | 2.33 |
|---|---|
| Citation span | 2023 - 2026 (4) |
| Highly cited | No |