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Time to add screening for financial hardship as a quality measure? ​

文献信息 ​

DOI10.3322/caac.21653
PMID33226648
期刊CA: a cancer journal for clinicians
影响因子232.4
JCR 分区Q1
发表年份2021
被引次数24
关键词癌症，差异，经济困难，质量测量，筛查
文献类型Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't
ISSN0007-9235
页码100-106
期号71(2)
作者Cathy J Bradley, K Robin Yabroff, S Yousuf Zafar, Ya-Chen Tina Shih

一句话小结 ​

研究指出，癌症治疗给患者和家庭带来了显著的经济困难，但在临床实践中关于费用的讨论和资源转介不足。作者建议将经济困难筛查纳入肿瘤科实践的质量指标，以改善癌症护理结果并减轻患者的经济负担。

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癌症 · 差异 · 经济困难 · 质量测量 · 筛查

摘要 ​

癌症治疗给许多患者和家庭带来了经济困难。目前，筛查经济困难和转介适当的资源以减轻这种困难并不是大多数临床实践的一部分。实际上，在临床实践中，关于治疗费用的讨论发生得非常少。随着癌症治疗费用的持续上升，减轻经济困难带来的不利后果的需求变得愈加迫切。质量测量和报告的引入在建立护理标准、减少护理接受差异以及改善癌症护理结果的其他方面取得了成功，涵盖了不同的医疗提供者。作者提议将经济困难的筛查和管理纳入肿瘤科实践的附加质量指标。他们建议相关利益相关者、组织者以及制定、测试和实施筛查与管理工具的方法，并倡导获得如国家质量论坛和肿瘤护理专业协会等组织的支持。随着高成本护理的增加以及因保险不足和缺乏健康保险覆盖而导致的支付能力差距扩大，采取措施减轻癌症带来的经济后果的必要性愈加明显。

英文摘要 ​

Cancer treatment is associated with financial hardship for many patients and families. Screening for financial hardship and referrals to appropriate resources for mitigation are not currently part of most clinical practices. In fact, discussions regarding the cost of treatment occur infrequently in clinical practice. As the cost of cancer treatment continues to rise, the need to mitigate adverse consequences of financial hardship grows more urgent. The introduction of quality measurement and reporting has been successful in establishing standards of care, reducing disparities in receipt of care, and improving other aspects of cancer care outcomes within and across providers. The authors propose the development and adoption of financial hardship screening and management as an additional quality metric for oncology practices. They suggest relevant stakeholders, conveners, and approaches for developing, testing, and implementing a screening and management tool and advocate for endorsement by organizations such as the National Quality Forum and professional societies for oncology care clinicians. The confluence of increasingly high-cost care and widening disparities in ability to pay because of underinsurance and lack of health insurance coverage makes a strong argument to take steps to mitigate the financial consequences of cancer.

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主要研究问题 ​

  1. 在实施财务困难筛查时，如何确保患者的隐私和数据安全？
  2. 目前有哪些成功的案例或模型可以借鉴，以推动癌症治疗中的财务困难筛查？
  3. 除了癌症治疗，其他医疗领域是否也面临类似的财务困难问题？如何进行比较？
  4. 如何评估财务困难筛查对患者治疗结果和生活质量的具体影响？
  5. 在不同地区或人群中，财务困难的表现和影响是否存在显著差异？如何进行针对性的干预？

核心洞察 ​

研究背景和目的 ​

癌症治疗常常导致患者及其家庭面临财务困难，这种情况在美国尤为明显。财务压力不仅会导致患者债务增加和破产风险，还会对其情感和身体健康产生负面影响。随着癌症治疗成本的不断上升，解决财务困难的需求愈加迫切。本文旨在提出将财务困难筛查和管理纳入肿瘤科质量指标的必要性，以改善癌症患者的整体护理质量。

主要方法/材料/实验设计 ​

本研究提出了一种系统化的流程来开发和实施财务困难筛查工具，主要步骤包括：

Mermaid diagram
  1. 识别财务困难：通过文献回顾和现有实践识别患者财务困难的普遍性和影响。
  2. 制定筛查工具：开发标准化的财务困难筛查工具，涵盖保险覆盖情况、医疗费用、非医疗费用等多个领域。
  3. 整合临床工作流程：确保筛查工具能够融入到现有的临床实践中。
  4. 开展筛查和管理计划：在患者治疗过程中定期进行财务困难筛查，并提供相应的管理计划。
  5. 连接患者与资源：为患者提供社区和机构的资源，帮助缓解财务压力。
  6. 评估和调整效果：定期评估筛查和管理计划的效果，并根据反馈进行调整。

关键结果和发现 ​

  • 财务困难对患者的治疗依从性、情感和身体健康产生显著影响，可能导致癌症生存率降低。
  • 现有的财务筛查实践在不同机构间存在显著差异，只有少数中心开展相关研究以评估效果。
  • 引入财务困难筛查工具能够帮助识别高风险患者，并连接到相应的支持资源。

主要结论/意义/创新性 ​

将财务困难筛查作为肿瘤科的质量指标，能够系统性地解决癌症患者面临的财务压力问题。这一措施不仅能改善患者的生活质量，还可能提高治疗依从性和生存率。通过专业组织的支持和质量指标的引入，能够促使临床实践更好地应对患者的财务需求。

研究局限性和未来方向 ​

  • 当前提出的筛查工具尚处于理论阶段，尚需进行实际测试和验证。
  • 需要进一步研究如何将财务困难筛查融入到不同规模的医疗机构中，以确保广泛适用性。
  • 未来应探索更多的资源整合和政策支持，以缓解癌症患者的财务负担，尤其是在新药物和治疗方案日益昂贵的背景下。

参考文献 ​

  1. Health Insurance Literacy and Financial Hardship in Women Living With Metastatic Breast Cancer. - Courtney P Williams;Maria Pisu;Andres Azuero;Kelly M Kenzik;Ryan D Nipp;Monica S Aswani;Stephen T Mennemeyer;Jennifer Y Pierce;Gabrielle B Rocque - JCO oncology practice (2020)
  2. Patient and plan characteristics affecting abandonment of oral oncolytic prescriptions. - Sonya Blesser Streeter;Lee Schwartzberg;Nadia Husain;Michael Johnsrud - Journal of oncology practice (2011)
  3. Oncology navigators' perceptions of cancer-related financial burden and financial assistance resources. - Jennifer C Spencer;Cleo A Samuel;Donald L Rosenstein;Katherine E Reeder-Hayes;Michelle L Manning;Jean B Sellers;Stephanie B Wheeler - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2018)
  4. Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial. - Marie A Bakitas;Tor D Tosteson;Zhigang Li;Kathleen D Lyons;Jay G Hull;Zhongze Li;J Nicholas Dionne-Odom;Jennifer Frost;Konstantin H Dragnev;Mark T Hegel;Andres Azuero;Tim A Ahles - Journal of clinical oncology : official journal of the American Society of Clinical Oncology (2015)
  5. Is Health Insurance Literacy Associated With Financial Hardship Among Cancer Survivors? Findings From a National Sample in the United States. - Jingxuan Zhao;Xuesong Han;Zhiyuan Zheng;Matthew P Banegas;Donatus U Ekwueme;K Robin Yabroff - JNCI cancer spectrum (2019)
  6. Financial Support Models: A Case for Use of Financial Navigators in the Oncology Setting. - Daniel Sherman;Kristen L Fessele - Clinical journal of oncology nursing (2019)
  7. Current Practices for Screening and Management of Financial Distress at NCCN Member Institutions. - Nandita Khera;Jessica Sugalski;Diana Krause;Richard Butterfield;Nan Zhang;F Marc Stewart;Robert W Carlson;Joan M Griffin;S Yousuf Zafar;Stephanie J Lee - Journal of the National Comprehensive Cancer Network : JNCCN (2020)
  8. Cancer Drugs: An International Comparison of Postlicensing Price Inflation. - Philip Savage;Sarah Mahmoud;Yogin Patel;Hagop Kantarjian - Journal of oncology practice (2017)
  9. Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment. - Ethan Basch;Allison M Deal;Amylou C Dueck;Howard I Scher;Mark G Kris;Clifford Hudis;Deborah Schrag - JAMA (2017)
  10. Changes in Insurance Coverage and Access to Care for Young Adults in 2017. - Kevin N Griffith - The Journal of adolescent health : official publication of the Society for Adolescent Medicine (2020)

引用本文的文献 ​

  1. Medical Financial Hardship in Survivors of Adolescent and Young Adult Cancer in the United States. - Amy D Lu;Zhiyuan Zheng;Xuesong Han;Ruowen Qi;Jingxuan Zhao;K Robin Yabroff;Paul C Nathan - Journal of the National Cancer Institute (2021)
  2. Financial Hardship in Adolescent and Young Adult Oncology: The Need for Multidimensional and Multilevel Approaches. - John M Salsman;Sheetal M Kircher - JCO oncology practice (2022)
  3. Patient-reported benefit from proposed interventions to reduce financial toxicity during cancer treatment. - Emeline M Aviki;Bridgette Thom;Kenya Braxton;Andrew J Chi;Beryl Manning-Geist;Fumiko Chino;Carol L Brown;Nadeem R Abu-Rustum;Francesca M Gany - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2022)
  4. Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating. - Peter M Anderson;Stefanie M Thomas;Shauna Sartoski;Jacob G Scott;Kaitlin Sobilo;Sara Bewley;Laura K Salvador;Maritza Salazar-Abshire - Nutrients (2021)
  5. Treating the Whole Patient With Cancer: The Critical Importance of Understanding and Addressing the Trajectory of Medical Financial Hardship. - K Robin Yabroff;Ya-Chen Tina Shih;Cathy J Bradley - Journal of the National Cancer Institute (2022)
  6. Financial toxicity impact on younger versus older adults with cancer in the setting of care delivery. - Kelsey L Corrigan;Shuangshuang Fu;Ying-Shiuan Chen;Kelsey Kaiser;Michael Roth;Susan K Peterson;Ya-Chen T Shih;Reshma Jagsi;Sharon H Giordano;Robert J Volk;K Robin Yabroff;Mathew P Banegas;Chiara Acquati;Rena M Conti;Hilary Y Ma;Kimberly Ku;Y Nancy You;Grace L Smith - Cancer (2022)
  7. Policies and Practices to Address Cancer's Long-Term Adverse Consequences. - Cathy J Bradley;Sara Kitchen;Smita Bhatia;Julie Bynum;Gwen Darien;J Leonard Lichtenfeld;Randall Oyer;Lawrence N Shulman;Lisa Kennedy Sheldon - Journal of the National Cancer Institute (2022)
  8. Financial Hardship in Adult Survivors of Childhood Cancer in the Era After Implementation of the Affordable Care Act: A Report From the Childhood Cancer Survivor Study. - Paul C Nathan;I-Chan Huang;Yan Chen;Tara O Henderson;Elyse R Park;Anne C Kirchhoff;Leslie L Robison;Kevin Krull;Wendy Leisenring;Gregory T Armstrong;Rena M Conti;Yutaka Yasui;K Robin Yabroff - Journal of clinical oncology : official journal of the American Society of Clinical Oncology (2023)
  9. Defining the Role of the Modern Oncology Provider in Mitigating Financial Toxicity. - Christopher T Su;Veena Shankaran - Journal of the American College of Radiology : JACR (2023)
  10. Knowledge, Attitudes, and Resources of Frontline Oncology Support Personnel Regarding Financial Burden in Patients With Cancer. - Katherine E Reeder-Hayes;Caitlin B Biddell;Michelle L Manning;Donald L Rosenstein;Cleo A Samuel-Ryals;Jennifer C Spencer;Sophia Smith;Allison Deal;Mindy Gellin;Stephanie B Wheeler - JCO oncology practice (2023)

... (14 更多 篇文献)

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