Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA.
Brown School and Center for Health Economics and Policy, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, USA.
Oncologist. 2020 Jul;25(7):609-619. doi: 10.1634/theoncologist.2019-0703. Epub 2020 Feb 28.
Many cancer survivors struggle to choose a health insurance plan that meets their needs because of high costs, limited health insurance literacy, and lack of decision support. We developed a web-based decision aid, Improving Cancer Patients' Insurance Choices (I Can PIC), and evaluated it in a randomized trial.
Eligible individuals (18-64 years, diagnosed with cancer for ≤5 years, English-speaking, not Medicaid or Medicare eligible) were randomized to I Can PIC or an attention control health insurance worksheet. Primary outcomes included health insurance knowledge, decisional conflict, and decision self-efficacy after completing I Can PIC or the control. Secondary outcomes included knowledge, decisional conflict, decision self-efficacy, health insurance literacy, financial toxicity, and delayed care at a 3-6-month follow-up.
A total of 263 of 335 eligible participants (79%) consented and were randomized; 206 (73%) completed the initial survey (106 in I Can PIC; 100 in the control), and 180 (87%) completed a 3-6 month follow-up. After viewing I Can PIC or the control, health insurance knowledge and a health insurance literacy item assessing confidence understanding health insurance were higher in the I Can PIC group. At follow-up, the I Can PIC group retained higher knowledge than the control; confidence understanding health insurance was not reassessed. There were no significant differences between groups in other outcomes. Results did not change when controlling for health literacy and employment. Both groups reported having limited health insurance options.
I Can PIC can improve cancer survivors' health insurance knowledge and confidence using health insurance. System-level interventions are needed to lower financial toxicity and help patients manage care costs.
Inadequate health insurance compromises cancer treatment and impacts overall and cancer-specific mortality. Uninsured or underinsured survivors report fewer recommended cancer screenings and may delay or avoid needed follow-up cancer care because of costs. Even those with adequate insurance report difficulty managing care costs. Health insurance decision support and resources to help manage care costs are thus paramount to cancer survivors' health and care management. We developed a web-based decision aid, Improving Cancer Patients' Insurance Choices (I Can PIC), and evaluated it in a randomized trial. I Can PIC provides health insurance information, supports patients through managing care costs, offers a list of financial and emotional support resources, and provides a personalized cost estimate of annual health care expenses across plan types.
许多癌症幸存者在选择满足其需求的健康保险计划时遇到困难，这是由于费用高、健康保险知识有限以及缺乏决策支持。我们开发了一种基于网络的决策辅助工具，名为“改善癌症患者保险选择（I Can PIC）”，并在一项随机试验中对其进行了评估。
符合条件的个体（18-64 岁，癌症诊断时间不超过 5 年，会说英语，不符合医疗补助或医疗保险资格）被随机分配到 I Can PIC 或注意力控制健康保险工作表组。主要结果包括完成 I Can PIC 或对照组后健康保险知识、决策冲突和决策自我效能的变化。次要结果包括知识、决策冲突、决策自我效能、健康保险素养、财务毒性和 3-6 个月随访时的延迟护理。
共有 335 名符合条件的参与者中的 263 名（79%）同意并被随机分配；206 名（73%）完成了初始调查（I Can PIC 组 106 名，对照组 100 名），180 名（87%）完成了 3-6 个月的随访。与观看 I Can PIC 或对照组相比，I Can PIC 组的健康保险知识和一项评估理解健康保险信心的健康保险素养项目更高。在随访时，I Can PIC 组的知识保留率高于对照组；没有重新评估对健康保险的理解信心。两组在其他结果上没有显著差异。在控制健康素养和就业的情况下，结果没有变化。两组都报告说健康保险选择有限。
I Can PIC 可以提高癌症幸存者使用健康保险的健康保险知识和信心。需要进行系统层面的干预，以降低财务毒性并帮助患者管理护理费用。
不充分的健康保险会影响癌症治疗，并影响整体和癌症特异性死亡率。未参保或参保不足的幸存者报告的推荐癌症筛查较少，可能会因费用而延迟或避免所需的后续癌症护理。即使那些有足够保险的人也报告说难以管理护理费用。因此，健康保险决策支持和帮助管理护理费用的资源对癌症幸存者的健康和护理管理至关重要。我们开发了一种基于网络的决策辅助工具，名为“改善癌症患者保险选择（I Can PIC）”，并在一项随机试验中对其进行了评估。I Can PIC 提供健康保险信息，通过管理护理费用来支持患者，提供一系列财务和情感支持资源，并提供按计划类型计算的年度医疗费用的个性化估计。
