UWA Medical School, The University of Western Australia, M507, 35 Stirling Highway, Crawley, WA 6009, Australia. Email:
Cancer Council Western Australia, 420 Bagot Road, Subiaco, WA 6008, Australia. Email:
Aust Health Rev. 2020 Jun;44(3):355-364. doi: 10.1071/AH18250.
Objective The aim of this study was to explore Western Australian cancer patients' experiences of out-of-pocket expenses (OOPE) during diagnosis and cancer treatment using a phenomenological approach. Methods Semi-structured interviews were conducted with a purposive convenience sample of 40 Western Australian cancer patients diagnosed with breast, lung, prostate or colorectal cancer. Participants were asked about the impact of their diagnosis, the associated costs and their experience within the health system. Data were analysed using thematic content analysis. Results Three key themes influencing participant OOPE experiences were identified: (1) personal circumstances; (2) communication with health providers; and (3) coping strategies. Despite Australia's public healthcare system, several participants found the costs affected their financial security and resorted to coping strategies including medication rationing and restrictive household budgeting. The key themes had a complex and interrelated effect on patient OOPE experiences and were used to adapt Carrera et al.'s model of economic consequences of cancer treatment on the patient and patient coping to describe these relationships in a mixed healthcare system. Conclusion Organised efforts must be implemented to mitigate maladaptive coping strategies being used by cancer patients: (1) health providers should seek informed financial consent from patients before commencing treatment; and (2) financial aid and support schemes for cancer patients should be reviewed to ensure they are delivered equitably. What is known on this topic? The financial cost of cancer can have significant adverse effects on cancer patients. Although financial transparency is desired by cancer patients, its implementation in practice is not clear. What does this paper add? This study adapts a conceptual model for the economic consequences of a cancer diagnosis and repurposes it for a mixed public-private health system, providing a framework for understanding downstream consequences of cancer costs and highlighting opportunities for intervention. What are the implications for health practitioners? Health practitioners need to initiate discussions concerning treatment costs earlier with cancer patients. There are several resources and guides available to assist and facilitate financial transparency. Without urgent attention to the financial consequences of cancer treatment and related expenses, we continue to leave patients at risk of resorting to maladaptive coping strategies, such as medication rationing and restrictive household budgeting.
目的 本研究旨在采用现象学方法探讨西澳大利亚癌症患者在诊断和癌症治疗过程中的自付费用（OOPE）体验。
方法 采用方便目的抽样法，对 40 名被诊断患有乳腺癌、肺癌、前列腺癌或结直肠癌的西澳大利亚癌症患者进行半结构化访谈。要求参与者描述诊断对他们的影响、相关费用以及他们在卫生系统内的体验。使用主题内容分析法分析数据。
结果 确定了影响参与者 OOPE 体验的三个关键主题：（1）个人情况；（2）与卫生保健提供者的沟通；（3）应对策略。尽管澳大利亚实行公共医疗保健系统，但一些参与者发现费用影响了他们的财务安全，并采取了应对策略，包括限制药物使用和家庭预算。这些关键主题对患者的 OOPE 体验产生了复杂而相互关联的影响，并用于改编 Carrera 等人的癌症治疗对患者和患者应对的经济后果模型，以描述混合医疗保健系统中的这些关系。
结论 必须采取有组织的努力来减轻癌症患者使用的适应性应对策略：（1）卫生保健提供者在开始治疗前应向患者寻求知情的财务同意；（2）应审查针对癌症患者的经济援助和支持计划，以确保公平提供。
这在该主题上已知的内容是什么？癌症的财务成本可能对癌症患者产生重大不利影响。尽管癌症患者希望财务透明，但其实践中的实施情况尚不清楚。
这篇文章增加了什么？本研究改编了癌症诊断的经济后果的概念模型，并将其重新用于混合公共-私人医疗保健系统，为理解癌症成本的下游后果提供了框架，并强调了干预的机会。
这对卫生保健从业者有什么影响？卫生保健从业者需要更早地与癌症患者讨论治疗费用。有许多资源和指南可用于协助和促进财务透明。如果不紧急关注癌症治疗和相关费用的经济后果，我们将继续让患者面临采取适应性应对策略的风险，例如限制药物使用和家庭预算。
