Improving Cancer Patients’ Insurance Choices (I Can PIC): A Randomized Trial of a Personalized Health Insurance Decision Aid

Abstract

Background. Many cancer survivors struggle to choose a health insurance plan that meets their needs because of high costs, limited health insurance literacy, and lack of decision support. We developed a web-based decision aid, Improving Cancer Patients' Insurance Choices (I Can PIC), and evaluated it in a randomized trial. Materials and Methods. Eligible individuals (18-64 years, diagnosed with cancer for ≤5 years, English-speaking, not Medicaid or Medicare eligible) were randomized to I Can PIC or an attention control health insurance worksheet. Primary outcomes included health insurance knowledge, decisional conflict, and decision self-efficacy after completing I Can PIC or the control. Secondary outcomes included knowledge, decisional conflict, decision self-efficacy, health insurance literacy, financial toxicity, and delayed care at a 3-6-month follow-up. Results. A total of 263 of 335 eligible participants (79%) consented and were randomized; 206 (73%) completed the initial survey (106 in I Can PIC; 100 in the control), and 180 (87%) completed a 3-6 month follow-up. After viewing I Can PIC or the control, health insurance knowledge and a health insurance literacy item assessing confidence understanding health insurance were higher in the I Can PIC group. At follow-up, the I Can PIC group retained higher knowledge than the control; confidence understanding health insurance was not reassessed. There were no significant differences between groups in other outcomes. Results did not change when controlling for health literacy and employment. Both groups reported having limited health insurance options. Conclusion. I Can PIC can improve cancer survivors' health insurance knowledge and confidence using health insurance. System-level interventions are needed to lower financial toxicity and help patients manage care costs. The Oncologist 2020;25:609-619 Implications for Practice: Inadequate health insurance compromises cancer treatment and impacts overall and cancerspecific mortality. Uninsured or underinsured survivors report fewer recommended cancer screenings and may delay or avoid needed follow-up cancer care because of costs. Even those with adequate insurance report difficulty managing care costs. Health insurance decision support and resources to help manage care costs are thus paramount to cancer survivors' health and care management. We developed a web-based decision aid, Improving Cancer Patients' Insurance Choices (I Can PIC), and evaluated it in a randomized trial. I Can PIC provides health insurance information, supports patients through managing care costs, offers a list of financial and emotional support resources, and provides a personalized cost estimate of annual health care expenses across plan types.

Women Who Are Young, Non-White, and with Lower Socioeconomic Status Report Higher Financial Toxicity up to 1 Year After Breast Cancer Surgery: A Mixed-Effects Regression Analysis

“…Cancer centers could include resources either internally (e.g., financial navigators [39], which have been shown to reduce patients’ financial burden and anxiety and are recommended as part of treatment planning [40, 41]) or in in the region (e.g., certified application counselors or health insurance navigators) to discuss insurance options with patients [38, 42, 43]. For groups that are vulnerable to increased burden from care costs, facilitating insurance choices [35, 42–44] to best match their needs and providing broader social services could be needed. These services could be particularly relevant given the coronavirus pandemic and the high rates of unemployment, insurance loss, and subsequent financial hardship in the U.S. [45].…”

Predicting Future Utilization Using Self-Reported Health and Health Conditions in a Longitudinal Cohort Study: Implications for Health Insurance Decision Support

“…Decision aids may be quite useful as health insurance literacy interventions, which should focus on communicating the concepts of lowprobability, high-cost risks, and how different types of insurance can mitigate them. 9,27,28 While we find that our SHS-based models perform well in the aggregate, predicting population-level risk well, we also caution that they are not sufficiently accurate to guide individuals' insurance shopping decisions in all cases.…”

Decision aids for cancer survivors’ engagement with survivorship care services after primary treatment: a systematic review

“…Full texts were retrieved from 72 studies, and Google Scholar and citation searches identified 8 additional studies. A total of 16 studies satisfied the eligibility criteria and were included in this review [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53].…”

“…Most DAs were specific to the post-primary treatment survivorship phase, except ACP and insurance plan decisions after diagnosis [42,48,49,[51][52][53]. The users of the two DAs of ACP were broad, including the cancer population as a subgroup [42,48].…”

“…The context of the decision was first described, explaining the heightened risk of recurrent or second cancer, late or long-term physical and psychosocial effects, and the importance of goal setting near end-of-life. Next, a list of possible options was presented using methods such as storyboards or survivors' anecdotes [38,49], actual imaging results for the case of low-dose CT scan [40], pictorial representation of risks [41,50], and comparison tables [44]. Additionally, the DA on insurance plan selection provided personalized cost estimates for each option [49].…”