Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
Gynecol Oncol. 2024 Apr;183:53-60. doi: 10.1016/j.ygyno.2024.03.014. Epub 2024 Mar 21.
To evaluate existing distress screening to identify patients with financial hardship (FH) compared to dedicated FH screening and assess patient attitudes toward FH screening.
We screened gynecologic cancer patients starting a new line of therapy. Existing screening included: (1) Moderate/severe distress defined as Distress Thermometer score ≥ 4, (2) practical concerns identified from Problem Checklist, and (3) a single question assessing trouble paying for medications. FH screening included: (1) Comprehensive Score for Financial Toxicity (COST) tool and (2) 10-item Financial Needs Checklist to guide referrals. FH was defined as COST score < 26. We calculated sensitivity (patients with moderate/severe distress + FH over total patients with FH) and specificity (patients with no/mild distress + no FH over total patients with no FH) to assess the extent distress screening could capture FH. Surveys and exit interviews assessed patient perspectives toward screening.
Of 364 patients screened for distress, average age was 62 years, 25% were Black, 45% were Medicare beneficiaries, 32% had moderate/severe distress, 15% reported ≥1 practical concern, and 0 reported trouble paying for medications. Most (n = 357, 98%) patients also completed FH screening: of them, 24% screened positive for FH, 32% reported ≥1 financial need. Distress screening had 57% sensitivity and 77% specificity for FH. Based on 79 surveys and 43 exit interviews, FH screening was acceptable with feedback to improve the timing and setting of screening.
Dedicated FH screening was feasible and acceptable, but sensitivity was low. Importantly, 40% of women with FH would not have been identified with distress screening alone.
评估现有的困扰筛查方法，以确定有经济困难（FH）的患者，并评估患者对 FH 筛查的态度。
我们对开始新的治疗线的妇科癌症患者进行了筛查。现有的筛查包括：（1） 困扰温度计评分≥4 定义为中度/重度困扰，（2） 从问题清单中确定的实际问题，以及（3） 评估支付药物困难的单一问题。FH 筛查包括：（1） 财务毒性综合评分（COST）工具和（2） 10 项财务需求清单，以指导转介。FH 的定义为 COST 评分<26。我们计算了敏感性（中度/重度困扰+FH 的患者占 FH 总患者的比例）和特异性（无/轻度困扰+无 FH 的患者占无 FH 总患者的比例），以评估困扰筛查捕捉 FH 的程度。问卷调查和退出访谈评估了患者对筛查的看法。
在 364 名接受困扰筛查的患者中，平均年龄为 62 岁，25%为黑人，45%为医疗保险受益人，32%有中度/重度困扰，15%报告有≥1 个实际问题，0 报告支付药物有困难。大多数（n=357，98%）患者还完成了 FH 筛查：其中，24%筛查出 FH 阳性，32%报告有≥1 项财务需求。困扰筛查对 FH 的敏感性为 57%，特异性为 77%。基于 79 份问卷调查和 43 份退出访谈，FH 筛查是可以接受的，但反馈表明需要改进筛查的时机和设置。
专门的 FH 筛查是可行且可接受的，但敏感性较低。重要的是，单独使用困扰筛查，将有 40%的 FH 女性患者无法被识别。
