Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Kirstein 3, 330 Brookline Ave, Boston, MA 02215, USA.
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Kirstein 3, 330 Brookline Ave, Boston, MA 02215, USA; Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street Suite 514, Boston, MA 02115, USA.
Gynecol Oncol. 2024 Oct;189:119-124. doi: 10.1016/j.ygyno.2024.07.672. Epub 2024 Aug 2.
"Financial Toxicity" (FT) is the financial burden imposed on patients due to disease and its treatment. Approximately 50% of gynecologic oncology patients experience FT. This study describes the implementation and outcomes of a novel financial navigation program (FNP) in gynecologic oncology.
Patients presenting for initial consultation with a gynecologic oncologist from July 2022 to September 2023 were included. A FNP was launched inclusive of hiring a financial navigator (FN) in July 2022, and implementing FT screening in October 2022. We prospectively captured patient referrals to the FN, collecting clinical, demographic, financial and social needs information, along with FN interventions and institutional support service referrals. Referrals to the FN and support services were quantified before and after screening implementation.
There were 1029 patients with 21.6% seen before and 78.4% after screening initiation. Median age was 58 (IQR 46-68). The majority were non-Hispanic white (60%) with private insurance (61%). A total of 10.5% patients were referred to the FN. Transportation (32%), financial assistance (20.5%) and emotional support (15.4%) were the most common needs identified. A higher proportion of patients referred to the FN identified as Black, had government-funded insurance or diagnoses of uterine or cervical cancers (p < 0.05). Post-screening referrals to FN increased (5% vs. 12.9%, p < 0.001), while referrals to other support services decreased (9.5% vs. 2.9%, p < 0.001).
Implementation of the FNP was feasible, though presence of both a FN and FT screening maximized its effectiveness. Further investigation is needed to understand screening barriers and evaluate longer-term impact.
“财务毒性”（FT）是指因疾病及其治疗而给患者带来的经济负担。约有 50%的妇科肿瘤患者经历过 FT。本研究描述了一种新型财务导航计划（FNP）在妇科肿瘤学中的实施情况和结果。
纳入 2022 年 7 月至 2023 年 9 月期间首次就诊于妇科肿瘤学家的患者。2022 年 7 月推出 FNP，并于 2022 年 10 月开始进行 FT 筛查。我们前瞻性地收集了患者转介给财务导航员（FN）的情况，收集了临床、人口统计学、财务和社会需求信息，以及 FN 的干预措施和机构支持服务转介。在实施筛查前后，对 FN 和支持服务的转介进行了量化。
共有 1029 名患者，其中 21.6%在筛查前，78.4%在筛查后。中位年龄为 58 岁（IQR 46-68）。大多数是非西班牙裔白人（60%），有私人保险（61%）。共有 10.5%的患者被转介给 FN。最常见的需求是交通（32%）、经济援助（20.5%）和情绪支持（15.4%）。被转介给 FN 的患者中，黑人、有政府资助保险或诊断为子宫或宫颈癌的比例较高（p<0.05）。筛查后转介给 FN 的人数增加（5%比 12.9%，p<0.001），而转介给其他支持服务的人数减少（9.5%比 2.9%，p<0.001）。
FNP 的实施是可行的，尽管 FN 和 FT 筛查的同时存在最大限度地提高了其效果。需要进一步调查以了解筛查障碍并评估长期影响。
