Increasingly, medical interventions, medications and investigations with solid evidence of effectiveness for cancer patients are not subsidised in Australia, or only subsidised after lengthy delays. Clinicians may refrain from discussing these with patients out of concern that they will add to patient distress. Collaborative decision making however requires that patients are fully informed about options, included unfunded ones, in a manner that allows them to weigh up their potential usefulness with their clinician. Non-disclosure can lead to dissatisfaction. Useful communication strategies include
1) discussing a range of options, not just high cost therapies
2) identifying potential for out of pocket cost early in the discussion
3) discussing cost per month or cycle, then overall cost, based on patient parameters eg weight
4) linking to likely outcomes of the test or treatment
5) eliciting patient values and responding to emotion
6) assisting patients to identify potential sources of funding eg superannuation