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

项目总结/摘要 “财务毒性”是癌症诊断的一个有据可查的副作用，包括一系列材料， 心理和行为上的困难，如债务，破产，财务担忧，和治疗非 坚持。研究表明，所有患者，无论保险类型或社会经济地位， 易受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，最严重的影响配偶照顾者，其资产，收入和支出往往是不可分割的， 与患者的联系。一些研究表明，这些经济困难共同导致了 患者的生活质量和生存率以及护理人员的福祉和执行护理的能力存在差异 职责因此，减轻金融毒性的干预措施应解决以下各方共同的财务关切： 癌症患者及其配偶鉴于在日益严重的环境中迫切需要这种干预措施， 医疗保健成本，我们开发了一个金融导航干预与合作：1）消费者教育 和培训服务（CENTS），总部设在西雅图的金融教育和咨询组织;和2）病人 倡导者基金会（PAF），一个国家患者导航组织。根据我们的初步工作 为了证明在肿瘤临床环境中实施这种干预的可行性，我们提出了一种前瞻性的， 一项随机实用性试验，536名癌症患者-配偶照顾者将获得积极的财政支持。 导航或常规护理。干预措施将包括每月一次的金融知识教育视频， 与CENTS顾问和PAF个案经理联系六个月，他们将帮助这对夫妇 癌症护理的财务方面，包括预算管理，保险登记和优化， 共同支付援助和其他资源，以管理医疗和非医疗自付费用。常规护理 还将收到一次性的金融知识视频，以规范他们的经验。我们的目标是： 1)确定远程管理的金融导航程序对材料开发的影响 家庭经济困难，2）调查积极的财务导航是否改善了患者和 护理人员的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 财政脆弱，低收入，年轻和少数民族家庭的服务，并评估 干预在这些亚组中的效果。我们将使用调查，信用报告和医疗记录来评估结果 在基线、入组后6个月和12个月获得的数据。本研究的主要终点是 入学后一年内家庭经济困难的发生率。我们希望这项研究的结果 将表明积极的财务导航改善了癌症的财务，心理和临床结果 患者及其配偶照顾者，因此应该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.