Improving Health Insurance Experiences for Adolescent and Young Adult Cancer Patients

项目摘要 美国的癌症患者经常经历严重的自掏腰包费用困扰，因为他们 癌症治疗。青少年和青壮年(Aya)癌症患者在医疗保险方面面临更多缺口 比老年癌症患者的覆盖率更高。医疗费用对阿亚癌症患者有很大影响，因为 研究表明，他们更有可能借钱、负债，并在患癌症后申请破产 被诊断为癌症的患者比年龄较大的患者更多。改善医疗保险和与成本相关的 识字--即患者在选择和使用医疗保险时做出明智决定的能力， 了解特定于护理的财务概念，以及舒适地与提供者讨论财务负担-是 确保Aya癌症患者得到高质量的癌症护理所必需的。这笔赠款的目标是提炼 并试点测试现有的医疗保险教育计划(HIEP)，以提高保险知识和成本- 阿雅癌症患者的相关素养。我们将确定与健康保险相关的年龄差异 以及18-39岁被诊断为癌症的AYA的成本素养，并相应地调整HEP材料。 我们将在亨茨曼-山间青少年和青壮年(HI-AYA)癌症中进行这项研究 CARE计划，这是亨斯迈癌症研究所和山间医疗保健公司共同努力的项目。 我们将评估HI-Aya患者导航器提供的HiEP是否改善了Aya癌症患者的病情 医疗保险和与费用相关的识字与通常的航海护理相比，不包括教育 在保险和费用方面。我们的目标是：1)调整和完善医疗保险教育计划(HiEP)，以 阿雅癌症患者。为了通知对现有干预的适应，我们将进行半结构化 对Aya癌症患者的访谈(确诊年龄：18-26岁n=10；27-39岁n=10) 并对10名Aya癌症患者进行了改装后的HiEP的初步测试。2)进行基于远程医疗的试点 对80例AYA癌症患者进行HEP的随机对照试验(RCT)。假设：在 对于癌症患者，HiEP将是可行和可接受的，并提高他们的医疗保险素养和 与日常护理相比，具有成本相关的识字能力。3)评估和改进HEP，以便在更大的 RCT。我们将对随机选择的HiEP干预组参与者(18-26岁)进行访谈 年n=10；27-39年n=10)为了解他们的满意度，交付时的修改建议， 以及对干预主题和内容修改的建议。这项工作的长期目标是 1)实施可在肿瘤学中传播的可持续健康保险教育计划 全美的机构和2)影响关于Aya癌症患者获得的医疗保健政策 获得和使用医疗保险以及他们的医疗费用。

PROJECT ABSTRACT Cancer patients in the United States often experience severe distress about out-of-pocket costs due to their cancer treatment. Adolescent and young adult (AYA) cancer patients face more gaps in their health insurance coverage than older individuals with cancer. Medical costs have substantial effects on AYA cancer patients as studies show they are more likely to borrow money, go into debt, and file for bankruptcy after a cancer diagnosis than patients diagnosed with cancer at older ages. Improving health insurance and cost-related literacy – that is, a patient’s ability to make informed decisions about choosing and using health insurance, understanding financial concepts specific to care, and comfort discussing financial burden with providers – are necessary to ensuring AYA cancer patients receive high quality cancer care. The goal of this grant is to refine and pilot test an existing health insurance education program (HIEP) to improve insurance literacy and cost- related literacy among AYA cancer patients. We will identify age-related differences related to health insurance and cost literacy among AYAs diagnosed with cancer ages 18-39, and adapt the HIEP materials accordingly. We will conduct this study within the Huntsman-Intermountain Adolescent and Young Adult (HI-AYA) Cancer Care Program, which is a joint effort between the Huntsman Cancer Institute and Intermountain Healthcare. We will evaluate whether the HIEP delivered by the HI-AYA patient navigators improves AYA cancer patients’ health insurance and cost-related literacy compared to usual navigation care, which does not include education on insurance and costs. We aim to: 1) Adapt and refine a health insurance education program (HIEP) for AYA cancer patients. To inform adaptations to the existing intervention, we will conduct semi-structured interviews with AYA cancer patients (sampled within age of diagnosis: 18-26 years n=10; 27-39 years n=10) and pilot test the adapted HIEP with 10 AYA cancer patients. 2) Conduct a telemedicine-based pilot randomized controlled trial (RCT) of the HIEP among AYA cancer patients (n=80). Hypotheses: Among AYA cancer patients, the HIEP will be feasible and acceptable and improve their health insurance literacy and cost-related literacy compared to usual care. 3) Evaluate and refine the HIEP for dissemination in a larger RCT. We will conduct interviews with a randomly selected subset of HIEP intervention arm participants (18-26 years n=10; 27-39 years n=10) to understand their satisfaction, recommendations for modifications on delivery, and recommendations for intervention topics and content modifications. The long-term goals of this work are to 1) implement a sustainable health insurance education program that can be disseminated in oncology institutions throughout the United States and 2) influence health care policy about AYA cancer patients’ access to and use of health insurance and their medical costs.