Financial Toxicity Order Set: Implementing a Simple Intervention to Better Connect Patients With Resources

Abstract

PURPOSE: Financial toxicity of cancer treatment is well described in the literature, including characterizations of its risk factors, manifestations, and consequences. There is, however, limited research on interventions, particularly those at the hospital level, to address the issue. METHODS: From March 1, 2019, to February 28, 2022, a multidisciplinary team conducted a three-cycle Plan-Do-Study-Act (PDSA) process to develop, test, and implement an electronic medical record (EMR) order set to directly refer patients to a hospital-based financial assistance program. The cycles included an assessment of the efficacy of our current practice in connecting patients experiencing financial hardship with assistance, the development and piloting of the EMR referral order, and the broad implementation of the order set across our institution. RESULTS: In PDSA cycle 1, we found that approximately 25% of patients at our institution experienced some form of financial hardship, but most patients were not connected to available resources because of our referral mechanism. In PDSA cycle 2, the pilot referral order set was deemed feasible and received positive feedback. Over the 12-month study period (March 1, 2021-February 28, 2022) of PDSA cycle 3, 718 orders were placed for 670 unique patients across interdisciplinary providers from 55 treatment areas. These referrals resulted in at least $850,000 in US dollars (USD) in financial aid in 38 patients (mean = $22,368 USD). CONCLUSION: The findings from our three-cycle PDSA quality improvement project demonstrate the feasibility and efficacy of interdisciplinary efforts to develop a hospital-level financial toxicity intervention. A simple referral mechanism can empower providers to connect patients in need with available resources.

Patient-Reported Financial Burden of Treatment for Colon or Rectal Cancer

“…Despite the general upward trajectory, the magnitude of financial hardship and the presence of residual financial hardship after treatment completion varied by sociodemographic factors. Interventions to mitigate financial hardship have included financial screening for financial hardship, navigation and education programs, 34 , 35 , 36 referral order sets integrated into electronic medical record, 37 and the establishment of multidisciplinary financial tumor boards, 38 which have demonstrated feasibility and promising patient-level outcomes. Nevertheless, there is a need for tailored interventions to address the unique needs of specific patient groups.…”

Employment and workdays lost among spouses of cancer survivors: Intersection with gender across cancer treatment status

“…Nevertheless, few health care systems are able to identify caregivers in the electronic medical record 35 . Strategic implementation of new fields in the electronic health record that capture employment characteristics has the potential to spur conversations around the ways that cancer can impact employment and financial well‐being for both patients and caregivers 26,36 . Processes that support the standardization of these efforts, that reflect a focus on family‐centered care, will be a key step in reducing adverse employment outcomes, financial toxicity, and particularly inequities in financial and well‐being outcomes for patients and families.…”

“…35 Strategic implementation of new fields in the electronic health record that capture employment characteristics has the potential to spur conversations around the ways that cancer can impact employment and financial well-being for both patients and caregivers. 26,36 Processes that support the standardization of these F I G U R E 2 Probability of workdays lost to care for others by gender, spouse cancer treatment status, and employment characteristics. Presented as predicted probabilities adjusting for age (continuous, centered at the grand mean).…”