Improving Health Insurance Experiences for Adolescent and Young Adult Cancer Patients

项目摘要 美国的癌症患者经常会因为他们的身体状况而对自付费用感到严重的痛苦。 癌症治疗青少年和年轻成人（AYA）癌症患者在健康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AYA癌症患者有重大影响， 研究表明，他们更有可能借钱，陷入债务，并申请破产后，癌症 诊断出癌症的患者比年龄较大的患者多。改善医疗保险和与费用有关的 识字能力-即患者在选择和使用健康保险方面做出明智决定的能力， 理解特定于护理的财务概念，并与提供者讨论财务负担的舒适性- 确保AYA癌症患者获得高质量的癌症护理。这项资助的目标是 并对现有的健康保险教育计划（HIEP）进行试点测试，以提高保险知识和成本- AYA癌症患者的相关知识。我们将确定与健康保险相关的年龄相关差异 在18-39岁被诊断患有癌症的AYAs中进行扫盲，并相应地调整HIEP材料。 我们将在Huntsman-Intermountain Adolescent and Young Adult（HI-AYA）Cancer研究中心内开展本研究。 护理计划，这是亨斯迈癌症研究所和山间医疗保健之间的共同努力。 我们将评估HI-AYA患者导航器提供的HIEP是否改善了AYA癌症患者的生活质量。 与不包括教育的常规导航护理相比， 保险和费用。我们的目标是：1）调整和完善健康保险教育计划（HIEP）， AYA癌症患者为了适应现有的干预措施，我们将进行半结构化的 与AYA癌症患者的访谈（在诊断年龄内采样：18-26岁n=10; 27-39岁n=10） 并对10名AYA癌症患者进行了初步试验。2)开展远程医疗试点 AYA癌症患者中HIEP的随机对照试验（RCT）（n=80）。假设： AYA癌症患者，HIEP将是可行的和可接受的，并提高他们的健康保险素养， 与常规护理相比，成本相关的扫盲。3)评估和完善《高等教育优先政策》，以便在更大范围内传播， RCT。我们将对随机选择的HIEP干预组参与者（18-26岁）进行访谈 年龄n=10; 27-39岁n=10），以了解他们的满意度，交付时的修改建议， 以及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 美国各地的机构; 2）影响有关AYA癌症患者获取的医疗保健政策 健康保险和医疗费用的使用。

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.