Barriers to Financial Assistance Among Patients With Cancer Experiencing Financial Distress

Financial navigation is an evidence-based means of identifying and addressing the financial needs of patients with cancer, who are at elevated risk of financial hardship, and their caregivers. Before introducing a financial navigation intervention at several sites in North Carolina, researchers conducted a study based on in-depth, semi-structured interviews with 83 stakeholders who together were involved in providing financial assistance at one of 10 oncology care sites in the state (JCO Oncol Pract. 2022; Published online May 12. doi:10.1200/OP.21. 00894). Five of these centers were in rural counties, and the remaining 5 were in nonrural counties.

The aim of the researchers was to determine the events and actions, collectively termed processes, and how these worked together as mechanisms that were already in place for financially assisting patients with cancer and their caregivers. 

“Results have informed our current efforts to implement a multisite financial navigation intervention, which involves comprehensive financial toxicity screening and systematization of intake and referrals,” wrote Caitlin Biddell, MPSH, Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, and colleagues.

After conducting their interviews with stakeholders, Biddell and team developed a site-specific process map for each site. They then shared the map with site leadership and revised the map through successive iterations. 

In addition, the researchers used coding to thematically analyze stakeholder perspectives regarding aids and barriers to connecting patients and caregivers with financial assistance. They then reported their findings to the stakeholders. Finally, they synthesized themes and process maps across rural and nonrural sites separately and compared emergent themes between them.

As a result, they identified core elements of existing financial assistance processes among all sites. These included distress screening, including screening for financial concerns; referrals; resource connection points; and pharmaceutical, insurance, and community or foundation resources. 

On the basis of their analysis, the researchers found that the core elements of these processes were consistent between rural and nonrural practices and that aids and barriers to identifying and addressing patients’ financial needs were similar for both rural and nonrural sites.

More specifically, open communication among staff, providers, patients, and caregivers was a primary aid to accessing financial assistance. Barriers included insufficient staff resources, challenges in the routine identification of need, poor preparation of patients for upcoming costs, and inadequate tracking of the availability of resources and eligibility requirements.

“Our findings suggest several opportunities to improve current financial assistance processes through the implementation of financial navigation,” Dr Biddell and team wrote, adding, “First, screening both proactively and comprehensively throughout treatment ensures equitable allocation of financial resources. …single checkboxes for patients to identify financial or insurance concerns are not sufficient to capture the full scope of patient financial needs.”

“Second, financial navigation will provide an infrastructure to support patient intake and referral tracking. This will streamline existing processes, document resources to which patients are successfully referred, and limit reliance on personal organization systems,” wrote Dr Biddle and colleagues, concluding, "Finally, financial navigation involves building networks of financial navigators across cancer centers and connecting navigators to nonprofits with experience in navigation.”