Rice Hannah E, L'Hotta Allison J, Siječić Amela, Drake Bettina F, Chang Su-Hsin, Kim Eric H, Wright-Jones Robin, Shahid Mellve, Neal Camille, Housten Ashley J
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Brown School of Social Work, Prevention Research Center, Washington University in St. Louis, St. Louis, MO, USA.
MDM Policy Pract. 2024 Oct 7;9(2):23814683241282413. doi: 10.1177/23814683241282413. eCollection 2024 Jul-Dec.
Financial hardship is prevalent among Black prostate cancer survivors and exacerbates health disparities. Characterizing and sharing cost information with patients can facilitate well-informed treatment decision making. Our research explored the direct and indirect costs associated with prostate cancer treatment among Black men and their caregivers. Direct costs included out-of-pocket and insurance-related fees, and indirect costs included the unforeseen costs of care, including patient time, caregiver time, lost wages, and transportation. We conducted semi-structured interviews with Black prostate cancer survivors and their caregivers to learn about the experience of direct and indirect costs. The interview guide and data analysis were informed by the Measures of Financial Wellbeing framework to gain a better understanding of the material, behavioral, and psychosocial aspects of care-related costs. Guided by a qualitative descriptive approach, we used inductive and deductive coding for our thematic analysis. Eleven prostate cancer survivors with a median age of 68 y (interquartile range [IQR] 62.0-71.5 y) and 11 caregivers with a median age of 64 y (IQR 58.5-70.5 y) participated. We grouped themes into 3 domains and their intersections (i.e., material, behavioral, psychosocial). Participants reported their work and insurance had a significant influence on their finances, treatment costs required rearranging of household budgets, and the weight of indirect costs varied. Ultimately, participants emphasized the significant impact of care costs and the adjustments needed to adapt to them. The complexities of material, behavioral, and psychosocial domains of direct and indirect costs of prostate cancer are critical to address when supporting those diagnosed with prostate cancer when making preference-sensitive treatment decisions. The interconnectedness between indirect costs highlights the wide-ranging impact financial well-being has on prostate cancer survivors and caregivers.
Direct and indirect costs have a wide-ranging impact on the material, behavioral, and psychosocial aspects of financial well-being of Black prostate cancer survivors and their caregivers.These results emphasize the need for sharing cost information to support medical decision making.Future research should focus on the design of cost-sharing interventions that target the complexities of direct and indirect costs collectively, rather than separately.
经济困难在黑人前列腺癌幸存者中普遍存在，且加剧了健康差距。向患者描述并分享费用信息有助于做出明智的治疗决策。我们的研究探讨了黑人男性及其护理人员前列腺癌治疗相关的直接和间接费用。直接费用包括自付费用和与保险相关的费用，间接费用包括护理的意外费用，如患者时间、护理人员时间、工资损失和交通费用。我们对黑人前列腺癌幸存者及其护理人员进行了半结构化访谈，以了解直接和间接费用的经历。访谈指南和数据分析以财务福祉衡量框架为依据，以便更好地理解护理相关费用的物质、行为和心理社会方面。在定性描述方法的指导下，我们在主题分析中使用了归纳和演绎编码。11名前列腺癌幸存者参与其中，年龄中位数为68岁（四分位间距[IQR]62.0 - 71.5岁），11名护理人员参与其中，年龄中位数为64岁（IQR 58.5 - 70.5岁）。我们将主题分为3个领域及其交叉点（即物质、行为、心理社会）。参与者报告称，他们的工作和保险对其财务状况有重大影响，治疗费用需要重新安排家庭预算，间接费用的负担各不相同。最终，参与者强调了护理费用的重大影响以及适应这些费用所需的调整。在支持前列腺癌患者做出偏好敏感的治疗决策时，解决前列腺癌直接和间接费用在物质、行为和心理社会领域的复杂性至关重要。间接费用之间的相互联系凸显了财务福祉对前列腺癌幸存者和护理人员的广泛影响。
直接和间接费用对黑人前列腺癌幸存者及其护理人员财务福祉的物质、行为和心理社会方面有广泛影响。这些结果强调了分享费用信息以支持医疗决策的必要性。未来的研究应侧重于设计针对直接和间接费用复杂性的成本分担干预措施，而不是分别针对这些复杂性。
