A Randomized Controlled Trial to Improve Health Insurance Literacy and Surveillance among Young Adult Cancer Survivors

摘要 癌症治疗结束后的第一年是建立年轻人生存护理(YA)的关键时期。 癌症幸存者年龄在26岁到39岁之间。接受循证生存护理，包括癌症监测 根据国家指南，YA幸存者的复发率仍然很低。与此同时，26岁至26岁的雅斯 在美国成年人中，39人的未参保率和保险不足率最高。我们团队之前的工作 表明YA癌症幸存者报告对他们的医疗保险和服务缺乏了解 覆盖，这影响了他们导航护理的能力。这些问题加在一起，可能会导致获得大量护理 障碍和对这一人群的严重医疗费用后果。这项建议解决了这一迫切需要 提高YA癌症幸存者的医疗保险素养，降低财务毒性，从而改善他们的 接受推荐的生存护理的能力。以安徒生和阿代的健康行为模型为指导 服务使用，我们开发并试点测试了YA癌症的4个疗程的虚拟患者导航干预 这是根据儿童癌症幸存者试点计划改编的。初步结果支持可行性， 对26岁至39岁的YA幸存者进行的这两项试点试验的可接受性和初步疗效。我们现在 提出一项随机对照试验，以检验该计划(Chat-S)对改善健康的效果 保险知识、医疗费用造成的财务毒性以及治疗后对复发的监测 癌症幸存者的年龄在26岁到39岁之间。我们计划将N=300(N=200干预；N=100常规护理)YAS随机分组 患有乳腺癌、睾丸癌、淋巴瘤、肉瘤和结直肠癌，并在 过去一年来自犹他大学医疗保健(UUHC)和山间医疗保健(IH)的14个地点 系统。UUHC和IH有许多农村(20%)和西班牙裔/拉丁裔(18%)YA癌症幸存者；我们将 对这些重要的亚群进行过度抽样。我们将确定Chat-S是否提高了医保素养 以及6个月随访时的财务毒性(主要结果)。此外，UUHC和IH拥有完整的数据 基础设施，使我们能够捕获电子健康记录和索赔数据，以调查 Chat-S改善了18个月随访期间复发的监测护理(次要结果)。我们会 探索干预效果的调节因素(例如，乡村、种族)。最后，为了给未来的传播提供信息， 我们将进行预算影响分析，并制定短期和长期的成本效益 分析了Chat-S。这项提案针对的是国家癌症研究所的目标，即改善对 癌症幸存者和减轻经济毒性。我们将展示虚拟健康保险素养 干预可以改善YA癌症患者的保险知识、财务毒性和监测护理 并为改善全美的生存护理提供指导。

ABSTRACT The first year after cancer treatment ends is a critical time to establish survivorship care for young adult (YA) cancer survivors ages 26 to 39. Receipt of evidence-based survivorship care, including surveillance for cancer recurrence based on national guidelines, remain low among YA survivors. At the same time, YAs ages 26 to 39 have the highest rate of both uninsurance and underinsurance among US adults. Our team’s prior work demonstrated that YA cancer survivors report low understanding of their health insurance and the services it covers, which affects their ability to navigate care. Together, these issues can lead to significant access to care barriers and severe medical cost consequences for this population. This proposal addresses the urgent need to improve YA cancer survivors’ health insurance literacy and decrease financial toxicity, thus improving their ability to receive recommended survivorship care. Guided by Andersen and Aday’s Behavioral Model of Health Services Use, we developed and pilot-tested a 4-session virtual patient navigation intervention for YA cancer survivors that was adapted from a pilot program for childhood cancer survivors. Initial results support feasibility, acceptability, and preliminary efficacy of both of these pilot trials with YA survivors ages 26 to 39. We now propose a randomized controlled trial to test the efficacy of this program (“CHAT-S”) to improve health insurance literacy, financial toxicity due to medical costs, and post-treatment surveillance for recurrence among YA cancer survivors ages 26 to 39. We plan to randomize N=300 (N=200 intervention; N=100 usual care) YAs with breast, testicular, lymphoma, sarcoma, and colorectal cancer who have completed initial treatment within the past year from 14 locations in the University of Utah Healthcare (UUHC) and Intermountain Healthcare (IH) systems. UUHC and IH have many rural (20%) and Hispanic/Latinx (18%) YA cancer survivors; we will oversample these important subgroups. We will determine whether CHAT-S improves health insurance literacy and financial toxicity at 6-month follow-up (primary outcomes). Further, UUHC and IH have an integrated data infrastructure which allows us to capture electronic health records and claims data to investigate whether CHAT-S improves surveillance care for recurrence at 18-month follow-up (secondary outcome). We will explore moderators (e.g., rurality, ethnicity) of the intervention effects. Finally, to inform future dissemination, we will conduct a budget impact analysis and a short-term and long-term time horizon cost-effectiveness analysis of CHAT-S. This proposal addresses the National Cancer Institute’s goal of improving the care of cancer survivors and mitigating financial toxicity. We will demonstrate that a virtual health insurance literacy intervention can improve insurance literacy, financial toxicity, and surveillance care among YA cancer survivors, and provide guidance to improving survivorship care across the United States.