Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences, Oklahoma City, OK, USA.
Department of Family Medicine, University of Oklahoma Health Sciences, Oklahoma City, OK, USA.
BMC Health Serv Res. 2024 Aug 14;24(1):928. doi: 10.1186/s12913-024-11357-6.
Cancer-related financial hardship is an increasingly recognized concern for patients, families, and caregivers. Many Native American (NA) patients are at increased risk for cancer-related financial hardship due to high prevalence of low income, medical comorbidity, and lack of private health insurance. However, financial hardship screening (FHS) implementation for NA patients with cancer has not been reported. The objective of this study is to explore facilitators and barriers to FHS implementation for NA patients.
We conducted key informant interviews with NA patients with cancer and with clinical staff at an academic cancer center. Included patients had a confirmed diagnosis of cancer and were referred to the cancer center through the Indian Health Service, Tribal health program, or Urban Indian health program. Interviews included questions regarding current financial hardship, experiences in discussing financial hardship with the cancer care and primary care teams, and acceptability of completing a financial hardship screening tool at the cancer center. Clinical staff included physicians, advanced practice providers, and social workers. Interviews focused on confidence, comfort, and experience in discussing financial hardship with patients. Recorded interviews were transcribed and thematically analyzed using MAXQDA® software.
We interviewed seven patients and four clinical staff. Themes from the interviews included: 1) existing resources and support services; 2) challenges, gaps in services, and barriers to care; 3) nuances of NA cancer care; and 4) opportunities for improved care and resources. Patients identified financial challenges to receiving cancer care including transportation, lodging, food insecurity, and utility expenses. Patients were willing to complete a FHS tool, but indicated this tool should be short and not intrusive of the patient's financial information. Clinical staff described discomfort in discussing financial hardship with patients, primarily due to a lack of training and knowledge about resources to support patients. Having designated staff familiar with I/T/U systems was helpful, but perspectives differed regarding who should administer FHS.
We identified facilitators and barriers to implementing FHS for NA patients with cancer at both the patient and clinician levels. Findings suggest clear organizational structures and processes are needed for financial hardship to be addressed effectively.
癌症相关的经济困难是患者、家属和护理人员日益关注的问题。许多美国原住民（NA）患者由于低收入、医疗合并症和缺乏私人医疗保险的高患病率而面临更高的癌症相关经济困难风险。然而，尚未报告针对癌症 NA 患者的经济困难筛查（FHS）实施情况。本研究的目的是探讨针对癌症 NA 患者实施 FHS 的促进因素和障碍。
我们对癌症的 NA 患者和学术癌症中心的临床工作人员进行了关键知情人访谈。纳入的患者均确诊患有癌症，并通过印第安卫生服务、部落卫生计划或城市印第安人健康计划转诊至癌症中心。访谈内容包括当前经济困难、与癌症护理和初级保健团队讨论经济困难的经历，以及在癌症中心完成经济困难筛查工具的可接受性。临床工作人员包括医生、高级实践提供者和社会工作者。访谈重点关注与患者讨论经济困难的信心、舒适度和经验。记录的访谈转录后，使用 MAXQDA®软件进行主题分析。
我们采访了 7 名患者和 4 名临床工作人员。访谈的主题包括：1）现有资源和支持服务；2）服务挑战、差距和护理障碍；3）NA 癌症护理的细微差别；4）改善护理和资源的机会。患者确定了接受癌症治疗的财务挑战，包括交通、住宿、食品不安全和水电费。患者愿意完成 FHS 工具，但表示该工具应该简短且不侵犯患者的财务信息。临床工作人员描述了与患者讨论经济困难时的不适，主要是由于缺乏培训和对支持患者资源的了解。有专门熟悉 I/T/U 系统的工作人员很有帮助，但对于应该由谁来进行 FHS 存在不同看法。
我们在患者和临床医生层面确定了实施癌症 NA 患者 FHS 的促进因素和障碍。研究结果表明，需要明确的组织结构和流程，以便有效地解决经济困难问题。
