Navigating the High Costs of Cancer Care: Opportunities for Patient Engagement

Gunn, Alexander; Sorenson, Corinna; Greenup, Rachel A.

doi:10.2217/fon-2021-0341

Cited by 8 publications

(2 citation statements)

References 91 publications

(99 reference statements)

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“…JL, like many under-insured patients, was inadvertently overlooked by her oncology team to be at risk for what scholars refer to as "financial toxicity, " or the material and psychosocial hardship from high costs of care. Yet, as many as 64% of patients report financial hardship following a cancer diagnosis [1], and many face barriers, like those described above, that prohibit affordable access to needed cancer therapies [2,3]. We use this case study to describe the critical steps we took to adapt and implement a health insurance decision intervention for cancer patients and survivors like JL, while balancing intervention testing and adaptation with real-world needs during a global pandemic.…”

Section: Open Accessmentioning

confidence: 99%

A case study of adapting a health insurance decision intervention from trial into routine cancer care

et al. 2022

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Objective This study adapted Improving Cancer Patients’ Insurance Choices (I Can PIC), an intervention to help cancer patients navigate health insurance decisions and care costs. The original intervention improved knowledge and confidence making insurance decisions, however, users felt limited by choices provided in insurance markets. Using decision trees and frameworks to guide adaptations, we modified I Can PIC to focus on using rather than choosing health insurance. The COVID-19 pandemic introduced unforeseen obstacles, prompting changes to study protocols. As a result, we allowed users outside of the study to use I Can PIC (> 1050 guest users) to optimize public benefit. This paper describes the steps took to conduct the study, evaluating both the effectiveness of I Can PIC and the implementation process to improve its impact. Results Although I Can PIC users had higher knowledge and health insurance literacy compared to the control group, results were not statistically significant. This outcome may be associated with systems-level challenges as well as the number and demographic characteristics of participants. The publicly available tool can be a resource for those navigating insurance and care costs, and researchers can use this flexible approach to intervention delivery and testing as future health emergencies arise.

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Section: Open Accessmentioning

confidence: 99%

A case study of adapting a health insurance decision intervention from trial into routine cancer care

et al. 2022

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“…Cancer is a chronic disease that requires patients to engage with a health care team over time to discuss different treatment options [ 28 ]. PE in cancer care delivery results in higher quality of care, greater patient satisfaction, and improved cost containment [ 29 - 31 ]. Although further research is needed on the use of HIT among older adults diagnosed with cancer, it has been observed that these patients tend to demonstrate higher levels of activation and engagement in their health care.…”

Section: Introductionmentioning

confidence: 99%

Examining the Impact of Selected Sociodemographic Factors and Cancer-Related Fatalistic Beliefs on Patient Engagement via Health Information Technology Among Older Adults: Cross-Sectional Analysis

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2023

JMIR Aging

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Background Despite the role of health information technology (HIT) in patient engagement processes and government incentives for HIT development, research regarding HIT is lacking among older adults with a high burden of chronic diseases such as cancer. This study examines the role of selected sociodemographic factors and cancer-related fatalistic beliefs on patient engagement expressed through HIT use for patient engagement in adults aged ≥65 years. We controlled for cancer diagnosis to account for its potential influence on patient engagement. Objective This study has 2 aims: to investigate the role of sociodemographic factors such as race, education, poverty index, and psychosocial factors of cancer fatalistic beliefs in accessing and using HIT in older adults and to examine the association between access and use of HIT in the self-management domain of patient activation that serves as a precursor to patient engagement. Methods This is a secondary data analysis of a subset of the Health Information National Trend Survey (Health Information National Trend Survey 4, cycle 3). The subset included individuals aged ≥65 years with and without a cancer diagnosis. The relationships between access to and use of HIT to several sociodemographic variables and psychosocial factors of fatalistic beliefs were analyzed. Logistic and linear regression models were fit to study these associations. Results This study included 180 individuals aged ≥65 years with a cancer diagnosis and 398 without a diagnosis. This analysis indicated that having less than a college education level (P=<.001), being an individual from an ethnic and minority group (P=<.001), and living in poverty (P=.001) were significantly associated with decreased access to HIT. Reduced HIT use was associated with less than a college education (P=.001) and poverty(P=.02). This analysis also indicated that fatalistic beliefs about cancer were significantly associated with lower HIT use (P=.03). Specifically, a 1-point increase in the cancer fatalistic belief score was associated with a 36% decrease in HIT use. We found that controlling for cancer diagnosis did not affect the outcomes for sociodemographic variables or fatalistic beliefs about cancer. However, patients with access to HIT had a self-management domain of patient activation (SMD) score of 0.21 points higher (P=.003) compared with patients who did not have access. SMD score was higher by 0.28 points (P=.002) for individuals who used HIT and 0.14 points higher (P=.04) who had a prior diagnosis of cancer. Conclusions Sociodemographic factors (education, race, poverty, and cancer fatalistic beliefs) impact HIT access and use in older adults, regardless of prior cancer diagnosis. Among older adults, HIT users report higher self-management, which is essential for patient activation and engagement.

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