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Screening and referral program to proactively identify financial hardship in adult patients with cancer and connect those at-risk with education, counseling, and resources. Patients with cancer will be screened as part of routine care and referred to available resources at their institution, following the referral processes developed and mapped in Aim 1.
In Aim 1, we will interview up to 30 clinical leaders and front-line staff across the two healthcare systems and community-based practices to understand workflows and opportunities for I-ACCESS integration. Assessment constructs will focus on understanding structural characteristics (including information technology infrastructure), available resources, culture, compatibility, relational connections, communications, and access to knowledge. These data will inform the creation of tailored process maps to outline processes and procedures to prepare each site for I-ACCESS implementation and elucidate when, how, and by whom I-ACCESS screening should be done.
In Aim 2, we will implement I-ACCESS as part of routine clinical practice for eight months at each site. Using a pre-/post-approach, we will examine whether I-ACCESS screening increases the number of financial counseling and oncology social work referrals (primary outcome). We will also examine counseling dispositions, receipt of services among those referred to financial support, and the predictive accuracy of the screening tool (secondary outcomes).
In Aim 3, we will analyze approximately 225 patient and 25 clinician surveys, informed by the Practical, Robust, Implementation and Sustainability Model, to gather feedback on I-ACCESS delivery, procedures, and barriers/facilitators to implementation. Based upon survey findings, we will then focus on key implementation determinants and outcomes through in-depth, semi-structured interviews with up to 40 stakeholders. Stakeholders will include patients, caregivers, healthcare providers, financial counselors, clinical support staff, and hospital administration at participating clinical sites.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Financial Screener | Other | Determine the effectiveness of the I-ACCESS screening tool in facilitating patient referrals for financial hardship counseling across diverse clinical practice settings. Patients who meet inclusion criteria will be screened for financial toxicity for financial toxicity using a 2-question screener tool developed from the COST ( a financial toxicity screening measure). Patients who screen positive for financial toxicity will be appropriately referred to available counseling resources. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Financial counseling and navigation | Behavioral | Patients who screen positive for financial toxicity on the 2-question screener tool, will be referred to available counseling or navigation resources available at each site. |
| Measure | Description | Time Frame |
|---|---|---|
| Screening completion | Ratio of the number of completed screens to the number of eligible patients | From enrollment to the end of the intervention at 8 months. |
| Rate of referral assistance | Ratio of the number of patients referred to counseling to the number of patients screened positive for financial distress | From enrollment to the end of the intervention at 8 months. |
| Measure | Description | Time Frame |
|---|---|---|
| Type of referral | Count/percent of reason for referral (out-of-pocket costs, non-medical expense, benefit counseling, medication cost, other) | From enrollment to the end of the intervention at 8 months. |
| Counseling content |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Brianna Connelly | Contact | 919-964-2343 | brianna_connelly@med.unc.edu |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Perlmutter Cancer Center | New York | New York | 10016 | United States |
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This is a multi-site, single arm, financial screening and referral intervention
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No masking
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Count/percent of counseling disposition (general, insurance, external referral, other)
| From enrollment to the end of the intervention at 8 months. |
| Applications for assistance | Count/percent of external referrals (including, but not limited to, foundation/charity support, local non-medical expense resources) | From enrollment to the end of the intervention at 8 months. |
| Referrals to external resources | Count/percent of external referrals (including, but not limited to, foundation/charity support, local non-medical expense resources) | From enrollment to the end of the intervention at 8 months. |
| Predictive accuracy of tool | Sensitivity, specificity, positive predictive value, and negative predictive value of tool vs. documented bill-paying challenges | From enrollment through the end of data analysis at 12 months |
| Acceptability of Intervention Measure | Patient and clinician perception of intervention acceptability | 4-6 months after implementation of I-ACCESS |
| Intervention Appropriateness Measure | Patient and clinician perception of intervention appropriateness | 4-6 months after implementation of I-ACCESS |
| Feasibility of Intervention Measure | Patient and clinician perception of intervention feasibility | 4-6 months after intervention completion |
| Cone Health Alamance Regional | Burlington | North Carolina | 27215 | United States |
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| University of North Carolina at Chapel Hill | Chapel Hill | North Carolina | 27599 | United States |
| UNC Health Pardee | Hendersonville | North Carolina | 28791 | United States |
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| ID | Term |
|---|---|
| D009369 | Neoplasms |
| D000086522 | Financial Stress |
| ID | Term |
|---|---|
| D013315 | Stress, Psychological |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
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