The Experience of Cancer Related Financial Hardship Among Individuals with Chronic Myeloid Leukemia in the Rural Southeast

项目总结 几乎三分之一的肿瘤科患者经历了与他们的癌症护理费用有关的经济困难(FH)。 经历过FH的人的健康结局更差，早期死亡率更高，压力更大， 生活质量(QOL)。由于结构性疾病，生活在农村地区的癌症患者不成比例地受到FH的影响 与生活在农村地区有关的个人层面的健康社会决定因素(SDOH)，以及 农村地区的癌症幸存者报告FH的人数比城市的癌症幸存者多。然而，人们对此知之甚少 为农村人群提供独特的FH体验。慢性粒细胞白血病(CML)的治疗成本和慢性化 治疗产生了一个理想的群体来研究，以更好地了解FH的经历。酪氨酸激酶 抑制剂(TKI)令人难以置信地延长了CML患者的预期寿命，但这些药物可以极大地 费用高昂，通常是无限期服用的。这会导致FH的风险、不坚持，以及潜在的健康状况不佳 结果。需要进一步探索FH的经验，以告知农村具体干预措施，以减少 FH的风险和这一人群的健康不平等。这个项目的目的是探索经验 对于居住在东南部农村地区的慢性粒细胞白血病患者来说，这是一种有效的治疗方法。该项目还将探索医疗保健 团队成员对农村CML患者FH体验的看法。来自患者和患者的信息 支持农村患者的医疗团队成员(如护士、药剂师、财务导航员和 需要社会工作者)，以更好地确定当前的做法、护理方面的差距，并为干预措施提供信息 减少FH和农村人口的健康不平等现象。将使用定性描述性方法来引出 对体验和感知的深度描述。大约25名慢性粒细胞白血病患者正在接受 TKI，生活在东南部一个农村4+城乡连续体代码县，并经历FH测量 根据财务毒性(成本)的综合评分，以及大约10名医疗团队成员 将招募那些照顾东南部农村CML患者的人。数据将以半结构化的方式收集在- 深度访谈。这项研究的第一个目的是探索慢性粒细胞白血病患者的FH体验 通过a)描述癌症护理费用对物质条件、心理反应、 和应对与经济困难有关的行为，以及b)探索农村地区生活的独特方面，如 它们与癌症护理的经济困难有关。这项研究的第二个目标是探索医护人员 对居住在农村地区的慢性粒细胞白血病患者的FH体验的看法，通过a)描述结构和 个人水平的风险因素影响农村CML人群的FH和b)描述策略和资源 目前可用于临床环境、需要缓解FH的领域，并建议干预策略以 解决农村地区的妇幼保健问题。这项研究将解决高危人群文献中的一个空白，即 受到癌症护理费用的挑战，同时提供证据，将导致农村特定干预措施 降低FH风险，改善农村癌症患者的健康状况和生活质量。

PROJECT SUMMARY Almost one-third of all oncology patients experience financial hardship (FH) related to their cancer care costs. People who experience FH have worse health outcomes, early mortality, increased stress, and decreased quality of life (QOL). Cancer patients living in rural areas are disproportionately affected by FH due to structural and individual level social determinants of health (SDOH) that are associated with living in a rural area, and more cancer survivors in rural areas report FH than their urban counterparts. However, little is known about the unique experience of FH for rural populations. The cost and the chronicity of Chronic Myeloid Leukemia (CML) treatment generates an ideal group to study to better understand the experience of FH. Tyrosine Kinase Inhibitors (TKIs) have incredibly extended life expectancy of CML patients, but these drugs can be extremely costly and usually are taken indefinitely. This results in risk for FH, nonadherence, and potential poor health outcomes. Further exploration of the experience of FH is needed to inform rural specific interventions to reduce the risk of FH and health inequities for this population. The purpose of this project is to explore the experience of FH for people with CML who live in rural areas of the Southeast. This project will also explore healthcare team member perceptions of the FH experience for rural CML patients. Information from both patients and healthcare team members supporting rural patients (such as nurses, pharmacists, financial navigators, and social workers) is needed to better identify current practices, gaps in care, and to inform interventions to reduce FH and health inequities for rural populations. A qualitative descriptive approach will be used to elicit deep description of experiences and perceptions. Approximately 25 participants with CML who are taking a TKI, living in a rural southeastern 4+ Rural-Urban Continuum Code county, and experiencing FH as measured by the Comprehensive Score for Financial Toxicity (COST), and approximately 10 healthcare team members who care for rural CML patients in the Southeast will be recruited. Data will be collected by semi-structured in- depth interviews. The first aim for this study is to explore the experience of FH in people with CML who live in rural areas by a) describing the impact of cancer care costs on material conditions, psychological responses, and coping behaviors related to financial hardship and b) exploring unique aspects of living in a rural area as they relate to financial hardship of cancer care. The second aim for this study is to explore healthcare staff perceptions of the FH experience for CML patients who live in rural areas by a) describing how structural and individual level risk factors impact FH for the rural CML population and b) describe strategies and resources currently available in clinical settings, areas of need to relieve FH, and recommend intervention strategies to address FH in rural areas. This study will address a gap in the literature for an at-risk population that is challenged by the costs of cancer care while providing evidence that will lead to rural specific interventions to reduce the risk of FH and improve health outcomes and QOL for rural cancer patients.