Incorporating cost considerations into shared decision-making: lessons from Bulgaria

This study aims to explore the need for and acceptability of incorporating treatment costs into shared decision-making (SDM) among patients and healthcare providers (HCPs) in Bulgaria. This study is a qualitative, non-interventional evaluation of patients’ and healthcare professionals’ needs, acceptability, and perceived barriers to introducing the cost dimension into SDM in routine clinical practice. The study was based on data collected through focus groups and semi-guided interviews conducted separately with both patients and HCPs. In total, the interviews involved thirteen HCPs (two oncohematologists and two hospital pharmacists; five physicians and one nurse from a multiple sclerosis (MS) clinic; and three endocrinologists), as well as eight oncological patients, six MS patients, and four diabetic patients. SDM is not a well-known concept among Bulgarian HCPs and patients. However, they use it in an unstructured manner. Both groups agreed that SDM is an important approach in mutual communication that improves treatment outcomes and enhances patient adherence. Patients who are required to make co-payments consider SDM discussions that include cost information as very important, while those whose treatment is fully reimbursed consider it less necessary. Participants agreed that digital tools supporting SDM and including the cost dimension should provide objective, evidence-based information and be validated. While digital tools can be useful in providing information, patients valued direct communication with physicians, which should not be replaced by tools.