评估虚拟导航干预对提高癌症幸存者医疗保险素养及减轻经济负担的效果：HINT II研究方案。
Assessing the effect of virtual navigation interventions to improve health insurance literacy and decrease financial burden in cancer survivors: The HINT II study protocol.
作者信息
Park Elyse R, Kirchhoff Anne C, Mitchell Calli O, Durieux Natalie, Foor Allyson, Kuhlthau Karen, Perez Giselle K, Ards Lakisa, Alston Shani, Armstrong Gregory T, Vaca Lopez Perla L, McDonald Aaron, Nolan Vikki G, Levy Douglas E, Leisenring Wendy M, Galbraith Alison A, Nathan Paul C, Vukadinovich Chris, Cooper Christie L, Donelan Karen
机构信息
Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Mongan Institute Health Policy Research Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA 02114, USA.
University of Utah Health Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
出版信息
Contemp Clin Trials. 2025 Jul;154:107952. doi: 10.1016/j.cct.2025.107952. Epub 2025 May 12.
BACKGROUND
Childhood cancer survivors often face high healthcare costs to monitor and manage new or lasting effects of their treatment. Enhancing survivors' health insurance literacy (HIL) - the knowledge, ability, and confidence in enrolling in and navigating health plans - is vital for minimizing financial burden. Few studies have assessed the effect of a health insurance navigation program on improving HIL among survivors. We present the protocol for an ongoing randomized controlled trial (RCT) assessing the effectiveness of two health insurance navigation programs (HINT-S and HINT-A) on improving HIL, financial burden, out-of-pocket costs, and healthcare utilization for adult survivors of childhood cancer.
METHODS
This three-arm RCT assesses the effectiveness of two digitally delivered health insurance navigation interventions and enhanced usual care (EUC) on improving HIL at six and 12 months in a national cohort of childhood cancer survivors. While HINT-S is composed of five synchronous, navigator-led sessions, HINT-A is an asynchronous, prerecorded set of five videos. EUC participants receive only a health insurance informational booklet. Financial burden, medical out-of-pocket costs, and healthcare utilization (receipt of preventive care, recommended screenings/vaccinations, and acute care) are assessed at 12 months. Moderators to the interventions' effectiveness will be investigated, as well as implementation outcomes (feasibility, acceptability, appropriateness, fidelity, and cost-effectiveness).
CONCLUSIONS
There is a strong need for interventions to improve cancer survivors' HIL, helping them navigate the complexity of the U.S. healthcare system. This trial will elucidate the potential effectiveness and implementation of health insurance navigation programs that may benefit many cancer survivors.
TRIAL REGISTRATION
NCT05527392.
背景
儿童癌症幸存者在监测和管理其治疗产生的新的或持续的影响时，往往面临高昂的医疗费用。提高幸存者的健康保险素养（即参与和使用健康保险计划的知识、能力和信心）对于减轻经济负担至关重要。很少有研究评估健康保险导航计划对提高幸存者健康保险素养的效果。我们介绍一项正在进行的随机对照试验（RCT）的方案，该试验旨在评估两项健康保险导航计划（HINT-S和HINT-A）对改善儿童癌症成年幸存者的健康保险素养、经济负担、自付费用和医疗保健利用情况的有效性。
方法
这项三臂随机对照试验评估了两项通过数字方式提供的健康保险导航干预措施以及强化常规护理（EUC）对全国儿童癌症幸存者队列在6个月和12个月时提高健康保险素养的有效性。HINT-S由五次由导航员主导的同步课程组成，而HINT-A是一组五个预先录制的异步视频。EUC参与者仅收到一本健康保险信息手册。在12个月时评估经济负担、医疗自付费用和医疗保健利用情况（接受预防性护理、推荐的筛查/疫苗接种和急性护理）。将调查干预措施有效性的调节因素以及实施结果（可行性、可接受性、适宜性、保真度和成本效益）。
结论
迫切需要采取干预措施来提高癌症幸存者的健康保险素养，帮助他们应对美国医疗保健系统的复杂性。这项试验将阐明可能使许多癌症幸存者受益的健康保险导航计划的潜在有效性和实施情况。
试验注册
NCT05527392。
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