Pilot implementation and qualitative evaluation of a financial hardship screening among Native American patients with cancer

• Published in: Supportive care in cancer 2024-12, Vol.32 (12), p.792, Article 792
• Main Authors: Janitz, Amanda E., Anderson-Buettner, Amber S., Madison, Stefani D., Doescher, Mark P., Nipp, Ryan, Buckner, Sheryl, Rhoades, Dorothy A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cancer; Female; Financial instruments; Financial Stress; Humans; Indians, North American; Male; Mass Screening - economics; Mass Screening - methods; Medicine; Medicine & Public Health; Middle Aged; Native North Americans; Neoplasms; Nursing; Nursing Research; Oncology; Pain Medicine; Pilot Projects; Poverty; Qualitative Research; Rehabilitation Medicine
• ISSN: 0941-4355; 1433-7339; 1433-7339
• DOI: 10.1007/s00520-024-08995-1

Purpose Native American (NA) patients with cancer are at increased risk of financial hardship due to lack of private health insurance coverage, medical comorbidities, and higher poverty rates. We aimed to implement and evaluate a pilot financial hardship screening (FHS) program among NA patients with cancer. Methods In 2022, we piloted the implementation of FHS among adult NA patients with cancer referred by NA-specific health facilities to an NCI-designated cancer center using the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) tool. We dichotomized COST-FACIT scores as mild/no hardship (26–44) and moderate/severe hardship (≤ 25). To evaluate the implementation, we conducted interviews with patients and clinical staff who participated in the screening process. We thematically analyzed interview transcriptions using inductive and deductive coding to identify themes. Results Of 42 patients completing FHS, 76.2% reported moderate/severe hardship. Ten patients and four clinical staff (1 physician, 3 NA navigation staff) completed interviews. We identified three themes: (1) FHS perceptions and intervention experiences, (2) FHS efficacy and opportunities for expansion, and (3) nuances for NA patients and patient-related factors. Patients expressed positive experiences with FHS, including identifying financial challenges, but preferences regarding timing varied. Staff reported logistic and sustainability challenges in implementing FHS. However, clinic staff reported positive experiences with the tool, interactions with patients, and the resulting supportive care referrals. Conclusion Implementation of FHS for NA patients with cancer was well received by patients and staff and was perceived by both groups as facilitating efforts to address financial hardship. Measures to improve staffing and sustainability are needed to enable broader implementation.