School of Nursing, Columbia University Irving Medical Center, New York, NY.
Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY.
JCO Clin Cancer Inform. 2023 Mar;7:e2200172. doi: 10.1200/CCI.22.00172.
Implementation of routine financial screening is a critical step toward mitigating financial toxicity. We evaluated the feasibility, sustainability, and acceptability of systematic financial screening in the outpatient breast oncology clinic at a large, urban cancer center.
We developed and implemented a stakeholder-informed process to systematically screen for financial hardship and worry. A 2-item assessment in English or Spanish was administered to patients through the electronic medical record portal or using paper forms. We evaluated completion rates and mode of completion. Through feedback from patients, clinicians, and staff, we identified strategies to improve completion rates and acceptability.
From March, 2021, to February, 2022, 3,500 patients were seen in the breast oncology clinic. Of them, 39% (n = 1,349) responded to the screening items, either by paper or portal, 12% (n = 437) preferred not to answer, and the remaining 49% (n = 1,714) did not have data in their electronic health record, meaning they were not offered screening or did not complete the paper forms. Young adults (18-39 years) were more likely to respond compared with patients 70 years or older (61% 30%, < .01). English-preferring patients were more likely to complete the screening compared with those who preferred Spanish (46% 28%, < .01). Non-Hispanic White patients were more likely to respond compared with Non-Hispanic Black patients and with Hispanic patients (46% 39% 32%, < .01). Strategies to improve completion rates included partnering with staff to facilitate paper form administration, optimizing patient engagement with the portal, and clearly communicating the purpose of the screening.
Systematic financial screening is feasible, and electronic data capture facilitates successful implementation. However, inclusive procedures that address language and technology preferences are needed to optimize screening.
实施常规财务筛查是减轻财务毒性的关键步骤。我们评估了在大型城市癌症中心的门诊乳腺癌诊所系统财务筛查的可行性、可持续性和可接受性。
我们开发并实施了一个利益相关者知情的流程，以系统地筛查财务困难和担忧。通过电子病历门户或纸质表格向患者提供了一个包含两部分的评估，患者可以用英语或西班牙语回答。我们评估了完成率和完成方式。通过患者、临床医生和工作人员的反馈，我们确定了提高完成率和可接受性的策略。
从 2021 年 3 月至 2022 年 2 月，有 3500 名患者在乳腺癌诊所就诊。其中，39%（n=1349）通过纸质或电子门户回答了筛查项目，12%（n=437）选择不回答，剩下的 49%（n=1714）在电子健康记录中没有数据，这意味着他们没有被提供筛查或没有完成纸质表格。与 70 岁及以上的患者相比，年轻患者（18-39 岁）更有可能回答（61% 30%，<.01）。与喜欢西班牙语的患者相比，喜欢英语的患者更有可能完成筛查（46% 28%，<.01）。与非西班牙裔黑人患者和西班牙裔患者相比，非西班牙裔白人患者更有可能回答（46% 39% 32%，<.01）。提高完成率的策略包括与工作人员合作，方便纸质表格的管理，优化患者与门户的互动，并清楚地传达筛查的目的。
系统的财务筛查是可行的，电子数据采集有助于成功实施。然而，需要制定包容各种语言和技术偏好的程序，以优化筛查。
