Addressing Cancer-Related Financial Hardship through Delivery of a Proactive Financial Navigation Intervention

项目摘要/摘要 “经济毒性”是癌症诊断的一种众所周知的副作用，它包括一系列材料， 心理上和行为上的困难，如债务、破产、财务担忧和非治疗 坚持不懈。研究表明，所有患者，无论保险类型或社会经济地位，都是 容易受到癌症诊断后的不利经济后果的影响。经济困难可能会影响整个 家庭，对配偶照顾者的影响最严重，他们的资产、收入和支出往往难以解决 与患者的联系。多项研究表明，这些经济困难共同导致了 患者的生活质量和生存以及照顾者的幸福感和照顾能力的差异 职责。因此，减轻金融毒害的干预措施应解决共同的金融关切。 癌症患者和他们的配偶。鉴于在不断上升的背景下迫切需要进行这种干预 医疗成本，我们与以下机构合作开发了金融导航干预：1)消费者教育 和培训服务(CONS)，一家总部位于西雅图的金融教育和咨询机构；以及2)患者 倡导基金会(PAF)，一个全国性的患者导航组织。根据我们的初步工作 为了证明在肿瘤临床环境中提供这种干预的可行性，我们提出了一个前瞻性的， 536名癌症患者-配偶照顾者双方将获得积极经济支持的随机务实试验 导航或日常护理。这次干预将包括一次性的金融知识教育视频，每月一次 联系六个月的美分辅导员和PAF案件经理，他们将帮助这对夫妇 癌症护理的财务方面，包括预算管理、保险登记和优化、获取 共同支付援助和其他资源，以管理医疗和非医疗自付费用。日常护理 还将收到一次性的金融知识视频，以规范自己的体验。我们的目标是： 1)确定远程管理的金融导航计划对材料开发的影响 家庭经济困难，2)调查主动财务导航是否改善了患者和 护理者心理社会和医疗保健利用结果，以及3)描述财务导航的使用 由经济脆弱、低收入、年轻和少数族裔家庭提供的服务，并评估 干预在这些亚组中的作用。我们将使用调查、信用报告和医疗记录来评估结果 在基线、注册后6个月和12个月获得的数据。这项研究的主要终点是 入学一年内家庭经济困难发生率。我们期待这项研究的结果 将显示积极的财务导航改善了癌症患者的财务、心理社会和临床结果 患者及其配偶照顾者，因此应成为高质量癌症护理的重要组成部分 在美国。

Project Summary/Abstract ‘Financial toxicity’ is a well-documented side effect of cancer diagnosis that encompasses a range of material, psychological, and behavioral hardships such as debt, bankruptcy, financial worry, and treatment non- adherence. Studies suggest that all patients, regardless of insurance type or socioeconomic status, are vulnerable to adverse financial consequences following cancer diagnosis. Financial hardship can impact entire families, most severely affecting spouse caregivers, whose assets, income, and expenses are often inextricably linked with patients’. A number of studies have shown that, collectively, these financial hardships contribute to disparities in patients’ quality of life and survival as well as caregivers’ well-being and ability to perform caregiving duties. Accordingly, interventions to mitigate financial toxicity should address the shared financial concerns of cancer patients and their spouses. Given the pressing need for such interventions in the context of rising healthcare costs, we developed a financial navigation intervention in collaboration with: 1) Consumer Education and Training Services (CENTS), a Seattle-based financial education and counseling organization; and 2) Patient Advocate Foundation (PAF), a national patient navigation organization. Based on our preliminary work demonstrating feasibility of delivering this intervention in the oncology clinic setting, we propose a prospective, randomized pragmatic trial in which 536 cancer patient - spouse caregiver dyads will receive proactive financial navigation or usual care. The intervention will consist of a one-time financial literacy education video, monthly contact for six months with CENTS counselors and PAF case managers who will help the couple with the financial aspects of cancer care, including budget management, insurance enrollment and optimization, access to copay assistance and other resources to manage medical and non-medical out-of-pocket costs. Usual care will also receive the one-time financial literacy video in order to standardize their experience. Our goals are to: 1) Determine the impact of a remotely-administered financial navigation program on development of material household financial hardship, 2) Investigate whether proactive financial navigation improves patient and caregiver psychosocial and healthcare utilization outcomes, and 3) Describe the use of financial navigation services by financially fragile, lower income, younger, and minority race households and evaluate the intervention’s effect in these subgroups. We will assess outcomes using survey, credit report, and medical record data obtained at baseline, six months, and twelve months post-enrollment. The primary endpoint of this study is incidence of household financial hardship within one year of enrollment. We expect that the results of this study will show that proactive financial navigation improves financial, psychosocial, and clinical outcomes in cancer patients and their spouse caregivers and should therefore be an essential component of high-quality cancer care in the United States.