Perceptions of barriers to patient financial hardship screening differ by provider role within gynecologic oncology outpatient care.

Authors

null

Jhalak Dholakia

University of Alabama at Birmingham, Birmingham, AL

Jhalak Dholakia, Maria Pisu, Warner King Huh, Margaret Irene Liang

Organizations

University of Alabama at Birmingham, Birmingham, AL, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health

Background: Although approximately half of patients with gynecologic malignancy experience financial hardship (FH) during treatment, best practices to identify and assist patients with FH are lacking. To develop such practices, we assessed oncology provider and staff perspectives about FH screening and provision of assistance. Methods: An anonymous survey was conducted electronically within the Gynecologic Oncology outpatient office at a Comprehensive Cancer Center. Potential barriers to patient FH screening and follow-up were assessed within 2 domains: 1) logistic barriers to incorporating FH screening and follow-up into outpatient workflow and 2) perceived patient barriers to FH screening. Responses were elicited on a 5-point Likert scale from ‘very’ to ‘not at all’ significant and dichotomized into significant and not significant barriers. Results: Of 43 providers approached, 37 responded (86% response rate) of which 14 were physicians (MD)/nurse practitioners (NP) and 23 were other staff members (i.e., clinical and research nurses, social workers, pharmacists, care coordinators, lay navigators, and financial counselors). Altogether, 38% worked in their current position for >5 years (n=14), 11% for 3-5 years (n=4), and 51% for <3 years (n=19). For logistic barriers to implementing FH screening and follow-up, the most frequently reported significant barriers included lack of personnel training (69%) and lack of available staff (62%), training regarding follow-up (72%), and case tracking infrastructure (67%). The most frequent significant perceived patient barriers were lack of knowledge of whom to contact (72%), concerns about impact on treatment if FH needs were identified (72%), and lack of patient readiness to discuss financial needs (62%.) Compared to MD/NP, staff members more often indicated the following as significant barriers: difficulty incorporating FH screening into initial visit workflow (31 % vs. 57%, p=0.03), overstretched personnel (29% vs 73%, p=0.005), and patient concerns about influence on treatment (62% vs 86%, p=0.01). Conclusions: Care team members identified barriers to patient FH screening across logistic and patient-centered domains, although MD/NP less so than other staff possibly reflecting different exposures to patient financial needs during clinical encounters or burden of workflow. Implementation of universal FH screening, dedicated personnel, convenient tracking mechanisms, and multi-disciplinary provider and staff training may improve recognition of patient FH and facilitate its integration into oncology care plans.

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Abstract Details

Meeting

2021 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B: Patient Experience; Quality, Safety, and Implementation Science; Technology and Innovation in Quality of Care

Track

Technology and Innovation in Quality of Care,Patient Experience,Quality, Safety, and Implementation Science,Cost, Value, and Policy,Health Care Access, Equity, and Disparities

Sub Track

Tools for Care Coordination

Citation

J Clin Oncol 39, 2021 (suppl 28; abstr 317)

DOI

10.1200/JCO.2020.39.28_suppl.317

Abstract #

317

Poster Bd #

Online Only

Abstract Disclosures

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