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

通过实施积极的财务导航干预措施解决与癌症相关的财务困难

• 批准号: 10363674
• 负责人: Veena Shankaran
• 金额: $ 61.98万
• 依托单位: FRED HUTCHINSON CANCER CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-16 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10363674
• 关键词: Address; Advocate; Affect; American Society of Clinical Oncology; Bankruptcy; Behavior Therapy; Behavioral; Budgets; Cancer Patient; Caregiver Burden; Caregiver well-being; Caregivers; Caring; Case Manager; Clinic; Clinical; Collaborations; Collection; Community Clinical Oncology Program; Counseling; Couples; Data; Data Reporting; Development; Diagnosis; Disease; Education; Emergency department visit; Enrollment; Facilities and Administrative Costs; Family; Family Study; Financial Hardship; Financial Support; Foundations; Goals; Health; Health Care Costs; Healthcare; Hospitalization; Hospitals; Household; Improve Access; Incidence; Income; Individual; Institutes; Insurance; Intervention; Judgment; Link; Low income; Malignant Neoplasms; Medical; Medical Care Costs; Medical Records; National Cancer Institute; Oncology; Outcome; Outcome Study; Participant; Patients; Pharmaceutical Preparations; Professional counselor; Quality of life; Race; Randomized; Recommendation; Reporting; Research; Resources; Risk; Role; Services; Social outcome; Socioeconomic Status; Spouse Caregiver; Spouses; Standardization; Subgroup; Surveys; Testing; Time; Training; Training and Education; Uninsured Medical Expense; United States; Work; arm; base; cancer care; cancer diagnosis; care delivery; caregiving; community organizations; cost; design; end of life; evidence base; exhaust; experience; financial literacy; financial toxicity; health care service utilization; health disparity; high risk; improved; intervention effect; medication nonadherence; minority children; novel; payment; pilot test; pragmatic trial; primary endpoint; primary outcome; programs; prospective; psychologic; psychosocial; response; side effect; treatment arm; treatment as usual

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.

项目摘要/摘要 “财务毒性”是癌症诊断的有据可查的副作用，包括一系列材料， 心理和行为困难，例如债务，破产，财务担忧和治疗 坚持。研究表明，不论保险类型或社会经济地位如何 癌症诊断后容易受到不利财务后果的影响。财务困难会影响整个 家庭，最严重影响的配偶护理人员，他们的资产，收入和费用通常是密不可分的 与患者有关。许多研究表明，这些财务困难总共有助于 患者生活质量和生存质量的差异以及照料者的福祉和执行照料的能力 职责。彼此之间，减轻财务毒性的干预措施应解决 癌症患者及其配偶。鉴于在上升的背景下需要这种干预措施 医疗保健费用，我们与：1）消费者教育开发了财务导航干预措施 和培训服务（CENTS），位于西雅图的金融教育和咨询组织； 2）病人 国家患者导航组织倡导者基金会（PAF）。根据我们的初步工作 在肿瘤学诊所环境中提供了这项干预的可行性，我们提出了一个前瞻性， 随机务实的试验中有536例癌症患者 - 配偶护理人员二元组将获得积极的财务 导航或通常的护理。干预措施将包括一次性的金融素养教育视频，每月 与Cents Counts和PAF案例经理联系六个月，他们将帮助这对夫妇 癌症护理的财务方面，包括预算管理，保险注册和优化，访问 共同援助和其他资源来管理医疗和非医疗自付费用。通常的护理 还将收到一次性的金融素养视频，以标准化其经验。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 家庭财务困难，2）调查主动财务导航是否改善患者和 照顾者的社会心理和医疗保健利用结果，3）描述财务导航的使用 通过财务脆弱，低收入，年轻和少数族裔家庭的服务，并评估 干预对这些亚组的影响。我们将使用调查，信用报告和病历评估结果 注册后的基线，六个月和十二个月在基线时获得的数据。这项研究的主要终点是 入学后一年内家庭经济困难的发生率。我们期望这项研究的结果 将表明，积极的金融导航可以改善癌症的金融，社会心理和临床结果 患者及其配偶护理人员，因此应该是高质量癌症护理的重要组成部分 在美国。