Doherty Meredith, Jacoby Jessica, Copeland Amy, Mangir Christina, Hodzic Rifeta Kajdic, Cadet Tamara J
School of Social Policy and Practice, University of Pennsylvania.
Small Spark Consulting, LLC.
J Oncol Navig Surviv. 2023 Jul;14(7):203-210. Epub 2023 Jul 19.
Cancer-related financial hardship is linked to poor health outcomes and early mortality. Oncology financial advocacy (OFA) aims to prevent cancer-related financial hardship in oncology settings by assessing patients' needs and connecting them to available financial resources. Despite promising evidence, OFA remains underutilized.
Describe oncology financial advocates' perceptions about the challenges to and opportunities for implementing oncology financial advocacy (OFA) in community cancer centers.
Nine virtual focus groups were conducted with 45 oncology financial advocates. Focus group transcripts were analyzed using template-based thematic analysis informed by the Consolidated Framework for Implementation Research (CFIR); two study team members coded each transcript and all six team members identified emergent themes.
Salient themes were identified across all five domains of the CFIR framework: (1) intervention characteristics: participants described challenges of adapting OFA to meet the needs of the medical system instead of needs of the patients; (2) outer setting: growing awareness of health and cancer disparities could bring more attention to and investment in OFA; (3) inner setting: programs are under-resourced to assist all at-risk patients, staffing, technology integration, and network/communication workflows are needed; (4) characteristics of individuals: advocates believe strongly in the effectiveness and would like to see their credibility enhanced with professional certification; (5) process: implementation strategies that target the engagement of leadership, key stakeholders, and patients to increase program reach are needed.
OFA cannot reach all at-risk patients because of understaffing, poor communication between departments, and a lack of understanding OFA as an intervention among colleagues, key stakeholders, and patients. To reach full implementation, advocates need assistance in making the case for more resources, research on patient outcomes, professional certification, and the use of policy to incentivize financial advocacy as a standard of care in medicine.
癌症相关的经济困难与不良健康结局和过早死亡有关。肿瘤学财务倡导（OFA）旨在通过评估患者需求并将其与可用财务资源相连接，预防肿瘤学环境中与癌症相关的经济困难。尽管有令人鼓舞的证据，但OFA的使用仍然不足。
描述肿瘤学财务倡导者对在社区癌症中心实施肿瘤学财务倡导（OFA）的挑战和机遇的看法。
与45名肿瘤学财务倡导者进行了9次虚拟焦点小组讨论。使用基于模板的主题分析对焦点小组记录进行分析，该分析由实施研究综合框架（CFIR）提供信息；两名研究团队成员对每份记录进行编码，所有六名团队成员确定新出现的主题。
在CFIR框架的所有五个领域中都确定了突出主题：（1）干预特征：参与者描述了使OFA适应医疗系统需求而非患者需求的挑战；（2）外部环境：对健康和癌症差异的认识不断提高，可能会使OFA得到更多关注和投资；（3）内部环境：项目资源不足，无法帮助所有有风险的患者，需要人员配备、技术整合以及网络/通信工作流程；（4）个人特征：倡导者坚信其有效性，并希望通过专业认证提高其可信度；（5）过程：需要实施针对领导层、关键利益相关者和患者参与的策略，以扩大项目覆盖范围。
由于人员不足、部门间沟通不畅以及同事、关键利益相关者和患者对OFA作为一种干预措施缺乏了解，OFA无法惠及所有有风险的患者。为了全面实施，倡导者需要在争取更多资源、研究患者结局、专业认证以及利用政策激励将财务倡导作为医疗护理标准方面获得帮助。
