Piloting a financial counseling intervention for patients with cancer receiving chemotherapy

Sheetal Mehta Kircher*, Jessica Yarber, Josh Rutsohn, Yanina Guevara, Madison Lyleroehr, Hannah Alphs Jackson, Jessica Walradt, Bijal Desai, Mary Frances Mulcahy, Aparna Kalyan, Al B Benson III, Mark Agulnik, Nisha Anjali Mohindra, Jonas DeSouza, Sofia F Garcia

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

PURPOSE National organizations encourage communication about costs of cancer care; however, few data are available on health system models for identifying and assisting patients with financial distress (FD). We report the feasibility and acceptability of a financial counseling (FC) intervention for patients who receive chemotherapy at a comprehensive cancer center. MATERIALS AND METHODS Patients were randomly assigned 1:1 to FC or standard care. The FC arm received education, financial assistance screening, and an estimation tool with total billed charges and out-of-pocket (OOP) cost of one cycle of chemotherapy from a financial counselor through phone call and in-person visit. Participants completed measures of FD, health-related quality of life, and acceptability. RESULTS Ninety-five participants enrolled (mean age, 61 years; 72% white; 50% commercially insured), with a 32% attrition rate between assessments. Rates of completion for the phone call, in-person, and entire intervention were 98%, 47%, and 30%, respectively. The OOP estimation tool was considered understandable and acceptable to the majority of participants. No significant changes in FD were found between arms. Emotional functioning was negatively associated with having high FD (95% CI, 20.13379 to 20.013; P = .0189). Being married was associated with a decrease in log-odds of having high FD (b = 21.916; 95% CI, 23.358 to 20.475; P = .0092). CONCLUSION Implementation of an FC program that provides transparent cost data is feasible and acceptable. Incorporation of FC into clinical workflow, including phone counseling, is important to improve feasibility. Additional work is needed to develop tailored educational materials that are patient specific.

Original languageEnglish (US)
Pages (from-to)E202-E210
JournalJournal of oncology practice
Volume15
Issue number3
DOIs
StatePublished - Mar 1 2019

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Counseling
Drug Therapy
Neoplasms
Costs and Cost Analysis
Workflow
Health Expenditures
Communication
Quality of Life
Organizations
Education
Health

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

Kircher, Sheetal Mehta ; Yarber, Jessica ; Rutsohn, Josh ; Guevara, Yanina ; Lyleroehr, Madison ; Jackson, Hannah Alphs ; Walradt, Jessica ; Desai, Bijal ; Mulcahy, Mary Frances ; Kalyan, Aparna ; Benson III, Al B ; Agulnik, Mark ; Mohindra, Nisha Anjali ; DeSouza, Jonas ; Garcia, Sofia F. / Piloting a financial counseling intervention for patients with cancer receiving chemotherapy. In: Journal of oncology practice. 2019 ; Vol. 15, No. 3. pp. E202-E210.
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abstract = "PURPOSE National organizations encourage communication about costs of cancer care; however, few data are available on health system models for identifying and assisting patients with financial distress (FD). We report the feasibility and acceptability of a financial counseling (FC) intervention for patients who receive chemotherapy at a comprehensive cancer center. MATERIALS AND METHODS Patients were randomly assigned 1:1 to FC or standard care. The FC arm received education, financial assistance screening, and an estimation tool with total billed charges and out-of-pocket (OOP) cost of one cycle of chemotherapy from a financial counselor through phone call and in-person visit. Participants completed measures of FD, health-related quality of life, and acceptability. RESULTS Ninety-five participants enrolled (mean age, 61 years; 72{\%} white; 50{\%} commercially insured), with a 32{\%} attrition rate between assessments. Rates of completion for the phone call, in-person, and entire intervention were 98{\%}, 47{\%}, and 30{\%}, respectively. The OOP estimation tool was considered understandable and acceptable to the majority of participants. No significant changes in FD were found between arms. Emotional functioning was negatively associated with having high FD (95{\%} CI, 20.13379 to 20.013; P = .0189). Being married was associated with a decrease in log-odds of having high FD (b = 21.916; 95{\%} CI, 23.358 to 20.475; P = .0092). CONCLUSION Implementation of an FC program that provides transparent cost data is feasible and acceptable. Incorporation of FC into clinical workflow, including phone counseling, is important to improve feasibility. Additional work is needed to develop tailored educational materials that are patient specific.",
author = "Kircher, {Sheetal Mehta} and Jessica Yarber and Josh Rutsohn and Yanina Guevara and Madison Lyleroehr and Jackson, {Hannah Alphs} and Jessica Walradt and Bijal Desai and Mulcahy, {Mary Frances} and Aparna Kalyan and {Benson III}, {Al B} and Mark Agulnik and Mohindra, {Nisha Anjali} and Jonas DeSouza and Garcia, {Sofia F}",
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Piloting a financial counseling intervention for patients with cancer receiving chemotherapy. / Kircher, Sheetal Mehta; Yarber, Jessica; Rutsohn, Josh; Guevara, Yanina; Lyleroehr, Madison; Jackson, Hannah Alphs; Walradt, Jessica; Desai, Bijal; Mulcahy, Mary Frances; Kalyan, Aparna; Benson III, Al B; Agulnik, Mark; Mohindra, Nisha Anjali; DeSouza, Jonas; Garcia, Sofia F.

In: Journal of oncology practice, Vol. 15, No. 3, 01.03.2019, p. E202-E210.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Piloting a financial counseling intervention for patients with cancer receiving chemotherapy

AU - Kircher, Sheetal Mehta

AU - Yarber, Jessica

AU - Rutsohn, Josh

AU - Guevara, Yanina

AU - Lyleroehr, Madison

AU - Jackson, Hannah Alphs

AU - Walradt, Jessica

AU - Desai, Bijal

AU - Mulcahy, Mary Frances

AU - Kalyan, Aparna

AU - Benson III, Al B

AU - Agulnik, Mark

AU - Mohindra, Nisha Anjali

AU - DeSouza, Jonas

AU - Garcia, Sofia F

PY - 2019/3/1

Y1 - 2019/3/1

N2 - PURPOSE National organizations encourage communication about costs of cancer care; however, few data are available on health system models for identifying and assisting patients with financial distress (FD). We report the feasibility and acceptability of a financial counseling (FC) intervention for patients who receive chemotherapy at a comprehensive cancer center. MATERIALS AND METHODS Patients were randomly assigned 1:1 to FC or standard care. The FC arm received education, financial assistance screening, and an estimation tool with total billed charges and out-of-pocket (OOP) cost of one cycle of chemotherapy from a financial counselor through phone call and in-person visit. Participants completed measures of FD, health-related quality of life, and acceptability. RESULTS Ninety-five participants enrolled (mean age, 61 years; 72% white; 50% commercially insured), with a 32% attrition rate between assessments. Rates of completion for the phone call, in-person, and entire intervention were 98%, 47%, and 30%, respectively. The OOP estimation tool was considered understandable and acceptable to the majority of participants. No significant changes in FD were found between arms. Emotional functioning was negatively associated with having high FD (95% CI, 20.13379 to 20.013; P = .0189). Being married was associated with a decrease in log-odds of having high FD (b = 21.916; 95% CI, 23.358 to 20.475; P = .0092). CONCLUSION Implementation of an FC program that provides transparent cost data is feasible and acceptable. Incorporation of FC into clinical workflow, including phone counseling, is important to improve feasibility. Additional work is needed to develop tailored educational materials that are patient specific.

AB - PURPOSE National organizations encourage communication about costs of cancer care; however, few data are available on health system models for identifying and assisting patients with financial distress (FD). We report the feasibility and acceptability of a financial counseling (FC) intervention for patients who receive chemotherapy at a comprehensive cancer center. MATERIALS AND METHODS Patients were randomly assigned 1:1 to FC or standard care. The FC arm received education, financial assistance screening, and an estimation tool with total billed charges and out-of-pocket (OOP) cost of one cycle of chemotherapy from a financial counselor through phone call and in-person visit. Participants completed measures of FD, health-related quality of life, and acceptability. RESULTS Ninety-five participants enrolled (mean age, 61 years; 72% white; 50% commercially insured), with a 32% attrition rate between assessments. Rates of completion for the phone call, in-person, and entire intervention were 98%, 47%, and 30%, respectively. The OOP estimation tool was considered understandable and acceptable to the majority of participants. No significant changes in FD were found between arms. Emotional functioning was negatively associated with having high FD (95% CI, 20.13379 to 20.013; P = .0189). Being married was associated with a decrease in log-odds of having high FD (b = 21.916; 95% CI, 23.358 to 20.475; P = .0092). CONCLUSION Implementation of an FC program that provides transparent cost data is feasible and acceptable. Incorporation of FC into clinical workflow, including phone counseling, is important to improve feasibility. Additional work is needed to develop tailored educational materials that are patient specific.

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DO - 10.1200/JOP.18.00270

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