Addressing Cancer-Related Financial Toxicity In Rural Oncology Care Settings

解决农村肿瘤护理机构中与癌症相关的财务毒性

• 批准号: 10459271
• 负责人: DONALD ROSENSTEIN
• 金额: $ 43.36万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10459271
• 关键词: Address; Affect; Affordable Care Act; American; Anxiety; Bankruptcy; Behavior; Behavioral; Cancer Burden; Cancer Etiology; Cancer Patient; Caring; Characteristics; Chronic Disease; Climate; Clinical; Community Clinical Oncology Program; Complex; Consolidated Framework for Implementation Research; Coping Behavior; Development; Distress; Effectiveness; Eligibility Determination; Evidence based intervention; Face; Family; Financial Hardship; Financial Support; Geography; Goals; Health; Health Insurance; Health Services Accessibility; Insurance; Insurance Coverage; Intervention; Interview; Life; Link; Logistics; Malignant Neoplasms; Manufacturer Name; Maps; Medical; Mental Health; Morbidity - disease rate; Oncology; Outcome; Participant; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; President' s Cancer Panel; Problem Solving; Process; Quality of Care; Readiness; Reporting; Resources; Rural; Rural Community; Rural Minority; Rural Population; Services; Shock; Structure; Surveys; System; Time; Training; Travel; Treatment Cost; Uninsured Medical Expense; Wages; Work; arm; barrier to care; behavioral outcome; behavioral response; cancer care; cancer health disparity; cancer site; care costs; care delivery; care outcomes; care providers; cost; effectiveness evaluation; emotional distress; evidence base; expectation; experience; financial toxicity; geographic barrier; health related quality of life; high risk; implementation determinants; implementation evaluation; implementation intervention; implementation outcomes; implementation strategy; improved; improved outcome; medically underserved population; minority patient; mortality; post implementation; post intervention; prescription drug costs; prevent; primary outcome; programs; psychologic; psychological outcomes; psychosocial; recruit; rural area; rural cancer care; rural patients; rural setting; satisfaction; secondary outcome; socioeconomics; uptake; urban disparity

PROJECT SUMMARY & ABSTRACT Financial toxicity (FT), a term used to describe the high cost and cost-related psychosocial burden that cancer care places on patients and their families, is a major and underappreciated problem affecting at least 20% of all cancer patients, with potentially devastating effects on outcomes. FT disproportionately affects patients in rural settings due to multiple socioeconomic, access, and clinical factors. A recent review of cancer-related financial hardship characterized the burden of FT as belonging to one of three domains: (1) material hardship, including high out-of-pocket expenses and lost wages; (2) psychological burden from distress and anxiety caused by high cancer costs; and (3) behavioral changes resulting from high cancer care costs, including changes in both medical and non-medical spending. Across cancer sites and stages, the considerable material hardship caused by cancer has been linked consistently to negative psychological and behavioral outcomes, including lower health-related quality of life, higher emotional distress, treatment delay/discontinuation, and filing for bankruptcy. Importantly, FT is also associated with increased mortality. Harmful psychological effects and care-altering behavioral responses, such as delaying or foregoing treatment, are more common in rural patients who also face considerable geographic barriers to care and greater financial vulnerability (e.g., lack of health insurance), likely contributing to widely-observed rural/urban disparities in cancer mortality. Interventions are urgently needed to prevent and mitigate high FT for cancer patients living in rural areas. Our prior work with patients, cancer care professionals, and a regional network of rural oncology practices argues strongly for intervening with financial navigation (FN), due to the complex material, structural, and psychological needs in this setting, fragmentation of existing financial support resources, and complicated assistance eligibility requirements. FN is one type of evidence-based intervention implemented at the practice or system level that can identify patients at high risk for FT, assess eligibility for existing federal, nonprofit, manufacturer, and local financial support resources, clarify treatment cost expectations, and develop strategies to cope with high costs of care. Our long-term goal is to improve cancer care delivery, reduce FT, and improve outcomes in underserved, rural populations through sustainable, scalable interventions. The objectives of this application are to: (1) understand the rural oncology practice context to optimize tailored strategies to support FN implementation; (2) assess FN intervention implementation in rural oncology practices; and (3) evaluate the effects of FN implementation on patient outcomes, including FT and health-related quality of life, in rural oncology practices. Our proposal is directly responsive to RFA-CA-18-026, which seeks to “improve the reach and quality of cancer care in rural populations”. Expected outcomes are the development and refinement of the operational and logistical processes needed to deliver effective FN in rural settings and reduction in FT, with potential to reduce rural outcome disparities.

项目摘要和摘要 财务毒性（FT），该术语用于描述癌症的高成本和与成本有关的伯恩 对患者及其家人的护理场所是一个重大且被低估的问题，影响至少20％ 癌症患者，对结局有潜在毁灭性影响。英尺不成比例地影响农村的患者 由于多个社会经济，访问和临床因素而引起的设置。最近对癌症相关财务的评论 艰苦的特征将ft的燃烧描述为属于三个领域之一：（1）物质困难，包括 高自付费用和损失的工资； （2）高高引起的心理灼伤和焦虑 癌症成本； （3）高癌症护理成本导致的行为改变，包括两者的变化 医疗和非医疗支出。跨癌症场所和阶段，造成的巨大物质困难 癌症一直与负面的心理和行为结果联系在一起，包括较低 与健康相关的生活质量，更高的情绪困扰，治疗延迟/中断以及破产申请。 重要的是，英尺也与死亡率增加有关。有害的心理影响和改变护理 行为反应，例如延迟或上述治疗，在面对的农村患者中更常见 大量的地理障碍和更大的财务脆弱性（例如缺乏健康保险），可能 在癌症死亡率中导致了广泛的农村/城市差异。迫切需要干预措施 为居住在农村地区的癌症患者预防和减轻高ft。我们先前与患者的工作，癌症护理 专业人士和农村肿瘤学实践的区域网络强烈主张干预财务 导航（FN），由于这种情况下的复杂材料，结构和心理需求，分散 现有的财务支持资源以及复杂的援助资格要求。 FN是一种类型 在实践或系统水平上实施的基于证据的干预措施，该干预措施可以识别高风险的患者 对于FT，对现有联邦，非营利组织，制造商和当地财务支持资源的评估资格，Clariify 治疗费用预期，并制定策略以应对高昂的护理费用。我们的长期目标是 通过 可持续，可扩展的干预措施。该应用程序的目标是：（1）了解粗糙的肿瘤学 实践背景，以优化量身定制的策略以支持FN实施； （2）评估FN干预 在粗糙的肿瘤学实践中实施； （3）评估实施FN对患者的影响 在粗糙的肿瘤学实践中，包括FT和与健康相关的生活质量在内的结果。我们的建议直接 对RFA-CA-18-026的反应，该RFA-CA-18-026试图“改善农村人群的癌症护理的覆盖范围和质量”。 预期的结果是所需的运营和后勤过程的发展和完善 在粗糙的环境中提供有效的FN并减少FT，并有可能减少农村结果分布。