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Machado S, Perez B, Papanicolas I. The role of race and ethnicity in health care crowdfunding: an exploratory analysis. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae027. [PMID: 38756917 PMCID: PMC10986198 DOI: 10.1093/haschl/qxae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 05/18/2024]
Abstract
Medical crowdfunding is a key source of financing for individuals facing high out-of-pocket costs, including organ-transplant candidates. However, little is known about racial disparities in campaigning activity and outcomes, or how these relate to access to care. In this exploratory, nationwide, cross-sectional study, we examined racial disparities in campaigning activity across states and the association between US campaigners' race and ethnicity and crowdfunding outcomes using a novel database of organ-transplant-related campaigns, and an algorithm to identify race and ethnicity based on name and geographic location. This analysis suggests that there are racial disparities in individuals' ability to successfully raise requested funds, with Black and Hispanic campaigners fundraising lower amounts and less likely to achieve their monetary goals. We also found that crowdfunding among White, Black, and Hispanic populations exhibits different patterns of activity at the state level, and in relation to race-specific uninsurance and waitlist additions, highlighting potential differences in fundraising need across the 3 groups. Policy efforts should consider not only how inequalities in fundraising ability for associated costs influence accessibility to care but also how to identify clinical need among minorities.
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Affiliation(s)
- Sara Machado
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI 02903, United States
- Department of Health Policy, London School of Economics, London WC2A 2AE, United Kingdom
| | - Beatrice Perez
- Department of Computer Science, University of Massachusetts, Boston, MA 02125, United States
| | - Irene Papanicolas
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI 02903, United States
- Department of Health Policy, London School of Economics, London WC2A 2AE, United Kingdom
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
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Waters AR, Easterly CW, Turner C, Ghazal L, Tovar I, Mulvaney M, Poquadeck M, Rains SA, Cloyes KG, Kirchhoff AC, Kent EE, Warner EL. LGBTQ+ inequity in crowdfunding cancer costs: The influence of online reach and LGBTQ+ state policy. Cancer Med 2024; 13:e6926. [PMID: 38275010 PMCID: PMC10905337 DOI: 10.1002/cam4.6926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Emerging literature suggests that LGBTQ+ cancer survivors are more likely to experience financial burden than non-LGBTQ+ survivors. However, LGBTQ+ cancer survivors experience with cost-coping behaviors such as crowdfunding is understudied. METHODS We aimed to assess LGBTQ+ inequity in cancer crowdfunding by combining community-engaged and technology-based methods. Crowdfunding campaigns were web-scraped from GoFundMe and classified as cancer-related and LGBTQ+ or non-LGBTQ+ using term dictionaries. Bivariate analyses and generalized linear models were used to assess differential effects in total goal amount raised by LGBTQ+ status. Stratified models were run by online reach and LGBTQ+ inclusivity of state policy. RESULTS A total of N = 188,342 active cancer-related crowdfunding campaigns were web-scraped from GoFundMe in November 2022, of which N = 535 were LGBTQ+ and ranged from 2014 to 2022. In multivariable models of recent campaigns (2019-2022), LGBTQ+ campaigns raised $1608 (95% CI: -2139, -1077) less than non-LGBTQ+ campaigns. LGBTQ+ campaigns with low (26-45 donors), moderate (46-87 donors), and high (88-240 donors) online reach raised on average $1152 (95% CI: -$1589, -$716), $1050 (95% CI: -$1737, -$364), and $2655 (95% CI: -$4312, -$998) less than non-LGBTQ+ campaigns respectively. When stratified by LGBTQ+ inclusivity of state level policy states with anti-LGBTQ+ policy/lacking equitable policy raised on average $1910 (95% CI: -2640, -1182) less than non-LGBTQ+ campaigns from the same states. CONCLUSIONS AND RELEVANCE Our findings revealed LGBTQ+ inequity in cancer-related crowdfunding, suggesting that LGBTQ+ cancer survivors may be less able to address financial burden via crowdfunding in comparison to non-LGBTQ+ cancer survivors-potentially widening existing economic inequities.
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Affiliation(s)
- Austin R. Waters
- Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
- Cancer Control and Population SciencesHuntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
| | - Caleb W. Easterly
- Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Cindy Turner
- College of NursingUniversity of UtahSalt Lake CityUtahUSA
| | - Lauren Ghazal
- Crowdfunding Cancer Costs (C3) LGBTQ+ Study Advisory BoardHuntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
- School of NursingUniversity of RochesterRochesterNew YorkUSA
| | - Ida Tovar
- College of NursingUniversity of UtahSalt Lake CityUtahUSA
| | - Megan Mulvaney
- Crowdfunding Cancer Costs (C3) LGBTQ+ Study Advisory BoardHuntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
- School of Public HealthIndiana University BloomingtonBloomingtonIndianaUSA
| | - Matt Poquadeck
- Crowdfunding Cancer Costs (C3) LGBTQ+ Study Advisory BoardHuntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
- Wilmot Cancer InstituteUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Stephen A. Rains
- Department of CommunicationUniversity of ArizonaTucsonArizonaUSA
| | - Kristin G. Cloyes
- School of NursingOregon Health and Science UniversityPortlandOregonUSA
| | - Anne C. Kirchhoff
- Cancer Control and Population SciencesHuntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
- Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Erin E. Kent
- Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Echo L. Warner
- Cancer Control and Population SciencesHuntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
- College of NursingUniversity of UtahSalt Lake CityUtahUSA
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Sturgeon C. Addressing financial toxicity in thyroid cancer survivors in the United States. Surgery 2024; 175:2-7. [PMID: 37953147 DOI: 10.1016/j.surg.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Cord Sturgeon
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Zhang X, Wang J, Lane JM, Xu X, Sörensen S. Investigating Racial Disparities in Cancer Crowdfunding: A Comprehensive Study of Medical GoFundMe Campaigns. J Med Internet Res 2023; 25:e51089. [PMID: 38085562 PMCID: PMC10751626 DOI: 10.2196/51089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/29/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In recent years, there has been growing concern about prejudice in crowdfunding; however, empirical research remains limited, particularly in the context of medical crowdfunding. This study addresses the pressing issue of racial disparities in medical crowdfunding, with a specific focus on cancer crowdfunding on the GoFundMe platform. OBJECTIVE This study aims to investigate racial disparities in cancer crowdfunding using average donation amount, number of donations, and success of the fundraising campaign as outcomes. METHODS Drawing from a substantial data set of 104,809 campaigns in the United States, we used DeepFace facial recognition technology to determine racial identities and used regression models to examine racial factors in crowdfunding performance. We also examined the moderating effect of the proportion of White residents on crowdfunding bias and used 2-tailed t tests to measure the influence of racial anonymity on crowdfunding success. Owing to the large sample size, we set the cutoff for significance at P<.001. RESULTS In the regression and supplementary analyses, the racial identity of the fundraiser significantly predicted average donations (P<.001), indicating that implicit bias may play a role in donor behavior. Gender (P=.04) and campaign description length (P=.62) did not significantly predict the average donation amounts. The race of the fundraiser was not significantly associated with the number of donations (P=.42). The success rate of cancer crowdfunding campaigns, although generally low (11.77%), showed a significant association with the race of the fundraiser (P<.001). After controlling for the covariates of the fundraiser gender, fundraiser age, local White proportion, length of campaign description, and fundraising goal, the average donation amount to White individuals was 17.68% higher than for Black individuals. Moreover, campaigns that did not disclose racial information demonstrated a marginally higher average donation amount (3.92%) than those identified as persons of color. Furthermore, the racial composition of the fundraiser's county of residence was found to exert influence (P<.001); counties with a higher proportion of White residents exhibited reduced racial disparities in crowdfunding outcomes. CONCLUSIONS This study contributes to a deeper understanding of racial disparities in cancer crowdfunding. It highlights the impact of racial identity, geographic context, and the potential for implicit bias in donor behavior. As web-based platforms evolve, addressing racial inequality and promoting fairness in health care financing remain critical goals. Insights from this research suggest strategies such as maintaining racial anonymity and ensuring that campaigns provide strong evidence of deservingness. Moreover, broader societal changes are necessary to eliminate the financial distress that drives individuals to seek crowdfunding support.
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Affiliation(s)
- Xupin Zhang
- School of Economics and Management, East China Normal University, Shanghai, China
| | - Jingjing Wang
- School of Economics and Management, East China Normal University, Shanghai, China
| | - Jamil M Lane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Xin Xu
- School of Economics and Management, East China Normal University, Shanghai, China
| | - Silvia Sörensen
- Warner School for Education and Human Development, University of Rochester, Rochester, NY, United States
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Killela M, Biddell C, Keim-Malpass J, Schwartz TA, Soto S, Williams J, Santacroce S. The Use of Medical Crowdfunding to Mitigate the Personal Costs of Serious Chronic Illness: Scoping Review. J Med Internet Res 2023; 25:e44530. [PMID: 38048149 PMCID: PMC10697184 DOI: 10.2196/44530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/11/2023] [Accepted: 10/26/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Persons diagnosed with serious chronic illnesses and their caretakers experience multiple types of financial costs that strain their income and generate financial distress. Many turn to medical crowdfunding (MCF) to mitigate the harms of these costs on their health and quality of life. OBJECTIVE This scoping review aims to summarize the research on MCF for persons diagnosed with serious chronic illness regarding study designs and methods; the responsible conduct of research practices; and study foci as they relate to stress, stress appraisals, and the coping processes. METHODS This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligible studies were conducted in countries designated as high income by the World Bank and focused on beneficiaries diagnosed with serious chronic illness. The findings of the included studies were summarized as they related to the key concepts in a conceptual framework derived from an established stress, appraisal, and coping framework and a conceptual model of financial toxicity in pediatric oncology. RESULTS Overall, 26 studies were eligible for inclusion in the review. The main findings included a lack of integration of qualitative and quantitative approaches and the inconsistent reporting of the responsible conduct of research practices. The included studies focused on financial stressors that contributed to financial burden, such as out-of-pocket payments of medical bills, basic living expenses, medical travel expenses, and lost income owing to illness-related work disruptions. Few studies addressed stress appraisals as threatening or the adequacy of available financial resources. When mentioned, appraisals related to the global financial struggle during the COVID-19 pandemic or the capacity of social network members to donate funds. The consequences of MCF included the receipt of 3 forms of social support (tangible, informational, and emotional), privacy loss, embarrassment, and the propagation of scientifically unsupported information. Studies found that friends and family tended to manage MCF campaigns. Although most of the studies (21/26, 81%) focused on monetary outcomes, a few (5/26, 19%) concentrated on peoples' experiences with MCF. CONCLUSIONS The identified methodological gaps highlight the need for more robust and reproducible approaches to using the copious data available on public MCF platforms. The integration of quantitative and qualitative methods will allow for nuanced explorations of the MCF experience. A more consistent elaboration of strategies to promote the responsible conduct of research is warranted to minimize risk to populations that are vulnerable and express concerns regarding the loss of privacy. Finally, an examination of the unanticipated consequences of MCF is critical for the development of future interventions to optimize existing supports while providing needed supports, financial and nonfinancial, that are lacking.
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Affiliation(s)
- Mary Killela
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Caitlin Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Todd A Schwartz
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sandra Soto
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jessica Williams
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sheila Santacroce
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Choi JW, Yoo AJ. Outcomes of the Pilot Project for Community Care Among Older Adults in South Korea. J Aging Soc Policy 2023:1-18. [PMID: 38007618 DOI: 10.1080/08959420.2023.2284571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/27/2023] [Indexed: 11/27/2023]
Abstract
The Korean government implemented the pilot project for community care for older adults in June 2019. This study investigated the outcomes of the pilot project among Korean older adults by linking survey data from the pilot project with data of Korean National Health Insurance Service. The final sample included 17,801 pilot project participants and 68,145 in a matched comparison group. Pilot program participants experienced an increase of 4.8 days for length of home stay and a reduction of $956 (US) per participant relative to the matched comparison group. Pilot program participants with long-term care insurance who used home care services experienced an increase of 8.9 days for length of home stay and a reduction in $1,177 (US) in total costs, along with a reduction in the admission to long-term care facilities, compared to the matched comparison group. Patients discharged from hospitals indicated an increase of 35.2 days for length of home stay and a reduction of $6,947 (US) in total costs, but a 3.53 times increase in hospital readmissions relative to the matched comparison group. The pilot project for community care resulted in increased length of home stay and reduced total costs among older adults in Korea.
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Affiliation(s)
- Jae Woo Choi
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Gangwon, Korea
| | - Ae Jung Yoo
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Gangwon, Korea
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Waters AR, Turner C, Easterly CW, Tovar I, Mulvaney M, Poquadeck M, Johnston H, Ghazal LV, Rains SA, Cloyes KG, Kirchhoff AC, Warner EL. Exploring Online Crowdfunding for Cancer-Related Costs Among LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer, Plus) Cancer Survivors: Integration of Community-Engaged and Technology-Based Methodologies. JMIR Cancer 2023; 9:e51605. [PMID: 37902829 PMCID: PMC10644187 DOI: 10.2196/51605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Cancer survivors frequently experience cancer-related financial burdens. The extent to which Lesbian, Gay, Bisexual, Transgender, Queer, Plus (LGBTQ+) populations experience cancer-related cost-coping behaviors such as crowdfunding is largely unknown, owing to a lack of sexual orientation and gender identity data collection and social stigma. Web-scraping has previously been used to evaluate inequities in online crowdfunding, but these methods alone do not adequately engage populations facing inequities. OBJECTIVE We describe the methodological process of integrating technology-based and community-engaged methods to explore the financial burden of cancer among LGBTQ+ individuals via online crowdfunding. METHODS To center the LGBTQ+ community, we followed community engagement guidelines by forming a study advisory board (SAB) of LGBTQ+ cancer survivors, caregivers, and professionals who were involved in every step of the research. SAB member engagement was tracked through quarterly SAB meeting attendance and an engagement survey. We then used web-scraping methods to extract a data set of online crowdfunding campaigns. The study team followed an integrated technology-based and community-engaged process to develop and refine term dictionaries for analyses. Term dictionaries were developed and refined in order to identify crowdfunding campaigns that were cancer- and LGBTQ+-related. RESULTS Advisory board engagement was high according to metrics of meeting attendance, meeting participation, and anonymous board feedback. In collaboration with the SAB, the term dictionaries were iteratively edited and refined. The LGBTQ+ term dictionary was developed by the study team, while the cancer term dictionary was refined from an existing dictionary. The advisory board and analytic team members manually coded against the term dictionary and performed quality checks until high confidence in correct classification was achieved using pairwise agreement. Through each phase of manual coding and quality checks, the advisory board identified more misclassified campaigns than the analytic team alone. When refining the LGBTQ+ term dictionary, the analytic team identified 11.8% misclassification while the SAB identified 20.7% misclassification. Once each term dictionary was finalized, the LGBTQ+ term dictionary resulted in a 95% pairwise agreement, while the cancer term dictionary resulted in an 89.2% pairwise agreement. CONCLUSIONS The classification tools developed by integrating community-engaged and technology-based methods were more accurate because of the equity-based approach of centering LGBTQ+ voices and their lived experiences. This exemplar suggests integrating community-engaged and technology-based methods to study inequities is highly feasible and has applications beyond LGBTQ+ financial burden research.
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Affiliation(s)
- Austin R Waters
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
| | - Cindy Turner
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Caleb W Easterly
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Ida Tovar
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Megan Mulvaney
- Crowdfunding Cancer Costs LGBT Study Advisory Board, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- School of Public Health, Indiana University Bloomington, Bloomington, IN, United States
| | - Matt Poquadeck
- Crowdfunding Cancer Costs LGBT Study Advisory Board, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Hailey Johnston
- Crowdfunding Cancer Costs LGBT Study Advisory Board, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
| | - Lauren V Ghazal
- Crowdfunding Cancer Costs LGBT Study Advisory Board, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Stephen A Rains
- Department of Communication, University of Arizona, Tucson, AZ, United States
| | - Kristin G Cloyes
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
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Galvin C, Yang W, Saadi A. Evaluation of Crowdsourced Fundraising to Cover Health Care Costs for Neurological Conditions in the US. JAMA Neurol 2023; 80:1000-1002. [PMID: 37459060 PMCID: PMC10352928 DOI: 10.1001/jamaneurol.2023.2235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/11/2023] [Indexed: 07/20/2023]
Abstract
This cross-sectional study characterizes the use of and rationale for crowdsourced fundraising by patients with neurological illnesses and their family members.
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Affiliation(s)
- Christopher Galvin
- Massachusetts General Brigham Neurology, Massachusetts General Hospital and Brigham and Women’s Hospital, Harvard Medical School, Boston
| | - Winni Yang
- Rutgers New Jersey Medical School, Newark
| | - Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Boston
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
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Davis AR, Elbers SK, Kenworthy N. Racial and gender disparities among highly successful medical crowdfunding campaigns. Soc Sci Med 2023; 324:115852. [PMID: 36989837 PMCID: PMC10916987 DOI: 10.1016/j.socscimed.2023.115852] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
There has been growing recognition of the popularity of medical crowdfunding and research documenting how crowdfunding arises from, and contributes to, social and health inequities. While many researchers have surmised that racism could well play a role in medical crowdfunding campaign outcomes, research on these dynamics has been limited. No research to date has examined these dynamics among the most successful medical crowdfunding campaigns, focusing instead on average users' experiences or specific patient subpopulations. This paper analyzes key characteristics and demographics of the 827 most successful medical crowdfunding campaigns captured at a point in time in 2020 on the popular site GoFundMe, creating the first demographic archetype of "viral" or highly successful campaigns. We hypothesized that this sample would skew towards whiter, younger populations, more heavily represent men, and reflect critical illnesses and accidents affecting these populations, in addition to having visually appealing, well-crafted storytelling. Analysis supported these hypotheses, showing significant levels of racial and gender disparities among campaigners. While white men had the greatest representation, Black and Asian users, and black women in particular, were highly underrepresented. Like other studies, we find evidence that racial and gender disparities persist in terms of campaign outcomes as well. Alongside this quantitative analysis, a targeted discourse analysis revealed campaign narratives and comments reinforced racist and sexist tropes of selective deservingness. These findings add to growing calls for more health research into the ways that social media technologies shape health inequities for historically marginalized and disenfranchised populations. In particular, we underscore how successful crowdfunding campaigns, as a both a means of raising funds for health and a broader site of public engagement, may deepen and normalize gendered and racialized inequities. In this way, crowdfunding can be seen as a significant technological amplifier of the fundamental social causes of health disparities.
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Affiliation(s)
- Aaron Renee Davis
- Department of Epidemiology, UW Box # 351619, Seattle, WA, 98195, School of Public Health, University of Washington, USA.
| | - Shauna K Elbers
- School of Interdisciplinary Arts and Sciences, 17927 113rd Ave NBox 358530, Bothell, WA, 98011-7909, University of Washington Bothell, USA
| | - Nora Kenworthy
- School of Nursing and Health Studies, Box #358532, 17927 113rd Ave NE, Bothell, WA, 98011-7909, University of Washington Bothell, USA
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10
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Livingstone A, Servais L, Wilkinson DJC. The ethics of crowdfunding in paediatric neurology. Dev Med Child Neurol 2023; 65:450-455. [PMID: 36271489 PMCID: PMC10952454 DOI: 10.1111/dmcn.15442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022]
Abstract
In the last decade, there has been a dramatic increase in the number of families resorting to internet-based public appeals to fund access to novel, highly expensive, or experimental therapies for rare disorders. Medical crowdfunding may provide a means to fund treatments or interventions, but it raises individual and societal ethical questions. In this review, we consider the ethical challenges crowdfunding poses in paediatric neurology, drawing on the example of gene therapy for spinal muscular atrophy. We discuss physician responsibilities, and how neurologists should respond to crowdfunding that they encounter in clinical practice. We also briefly consider actions that can be taken by clinicians, charities, and crowdfunding websites to reduce harms. The best way to mitigate these harms may be to target the high costs and restrictive criteria that limit access to many novel treatments, and to optimize treatment utility, for instance by newborn screening. WHAT THIS PAPER ADDS: Crowdfunding is a social phenomenon arising from families' inability to access desired treatment. Treatments sought by crowdfunding range from those that are clearly beneficial (but unaffordable) to those that would be ineffective and potentially harmful. Crowdfunding carries a range of harms and risks to families and children and has wider social impact.
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Affiliation(s)
| | - Laurent Servais
- MDUK Oxford Neuromuscular Centre, Department of PaediatricsUniversity of OxfordOxfordUK
- Neuromuscular Reference CenterUniversity Hospital and University of LiègeLiègeBelgium
| | - Dominic J. C. Wilkinson
- John Radcliffe HospitalOxfordUK
- Oxford Uehiro Centre for Practical Ethics, Faculty of PhilosophyUniversity of OxfordOxfordUK
- Murdoch Children's Research InstituteMelbourneAustralia
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11
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Ghazal LV, Watson SE, Gentry B, Santacroce SJ. "Both a life saver and totally shameful": young adult cancer survivors' perceptions of medical crowdfunding. J Cancer Surviv 2023; 17:332-341. [PMID: 35169983 PMCID: PMC9378759 DOI: 10.1007/s11764-022-01188-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/10/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Young adults (YAs) diagnosed with cancer face high financial burden at a time in their lives when they are financially vulnerable. Some turn to medical crowdfunding, that is, using social media and other means to raise funds or resources to offset medical and usual life expenses. Major research gaps exist regarding the experiences of those who pursued crowdfunding. Thus, the study purpose was to describe the perceptions of, and experiences with, medical crowdfunding among a sample of YA cancer survivors. METHODS In February 2021, we distributed an online survey to YAs with a history of a cancer diagnosis, who had received grants from an organization that offers financial assistance. We calculated descriptive statistics on the crowdfunding sample and employed thematic analysis to analyze the open-ended questions. RESULTS In this sample (N = 113), 46 YA cancer survivors had engaged in medical crowdfunding and shared their perceptions and experiences. Our central theme, "The Crowdfunding Compromise" captures the trade-offs participants faced, which included subthemes of "crowdfunding as useful/helpful," "factors associated with crowdfunding success," and "questioning the why?". CONCLUSIONS Among YA cancer survivors, medical crowdfunding brings shame and stigma in addition to financial support. YA cancer survivors demonstrate resilience in their attempts to find individual solutions to financial problems created by unchecked health care costs, the US health insurance infrastructure, and lack of legislation. IMPLICATIONS FOR CANCER SURVIVORS This study fills an important gap in understanding individual-level crowdfunding experiences. Implications include system-level approaches to addressing cancer-related financial burden and potential worsening of existing disparities through medical crowdfunding.
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Affiliation(s)
- Lauren V Ghazal
- Center for Improving Patient and Population Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
- Rogel Cancer Center, University of Michigan Ann, Arbor, MI, USA.
| | | | | | - Sheila J Santacroce
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Zhang X, Tao X, Ji B, Wang R, Sörensen S. The Success of Cancer Crowdfunding Campaigns: Project and Text Analysis. J Med Internet Res 2023; 25:e44197. [PMID: 36692283 PMCID: PMC10024214 DOI: 10.2196/44197] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/19/2022] [Accepted: 01/21/2023] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Recent studies have analyzed the factors that contribute to variations in the success of crowdfunding campaigns for a specific cancer type; however, little is known about the influential factors among crowdfunding campaigns for multiple cancers. OBJECTIVE The purpose of this study was to examine the relationship between project features and the success of cancer crowdfunding campaigns and to determine whether text features affect campaign success for various cancers. METHODS Using cancer-related crowdfunding projects on the GoFundMe website, we transformed textual descriptions from the campaigns into structured data using natural language processing techniques. Next, we used penalized logistic regression and correlation analyses to examine the influence of project and text features on fundraising project outcomes. Finally, we examined the influence of campaign description sentiment on crowdfunding success using Linguistic Inquiry and Word Count software. RESULTS Campaigns were significantly more likely to be successful if they featured a lower target amount (Goal amount, β=-1.949, z score=-82.767, P<.001) for fundraising, a higher number of previous donations, agency (vs individual) organizers, project pages containing updates, and project pages containing comments from readers. The results revealed an inverted U-shaped relationship between the length of the text and the amount of funds raised. In addition, more spelling mistakes negatively affected the funds raised (Number of spelling errors, β=-1.068, z score=-38.79, P<.001). CONCLUSIONS Difficult-to-treat cancers and high-mortality cancers tend to trigger empathy from potential donors, which increases the funds raised. Gender differences were observed in the effects of emotional words in the text on the amount of funds raised. For cancers that typically occur in women, links between emotional words used and the amount of funds raised were weaker than for cancers typically occurring among men.
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Affiliation(s)
- Xupin Zhang
- Department of Information Management, Faculty of Economics and Management, East China Normal University, Shanghai, China
| | - Xinqi Tao
- Department of Information Management, Faculty of Economics and Management, East China Normal University, Shanghai, China
| | - Bingxiang Ji
- Department of Information Management, Faculty of Economics and Management, East China Normal University, Shanghai, China
| | - Renwu Wang
- Department of Information Management, Faculty of Economics and Management, East China Normal University, Shanghai, China
| | - Silvia Sörensen
- Warner School of Education and Human Development, University of Rochester, Rochester, NY, United States
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13
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Waters AR, van Thiel Berghuijs KM, Kaddas HK, Vaca Lopez PL, Chevrier A, Ray N, Tsukamoto T, Allen K, Fair DB, Lewis MA, Perez GK, Park ER, Kirchhoff AC, Warner EL. Sources of informal financial support among adolescent and young adult cancer survivors: a mixed methods analysis from the HIAYA CHAT study. Support Care Cancer 2023; 31:159. [PMID: 36773110 PMCID: PMC10601020 DOI: 10.1007/s00520-023-07626-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/01/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE The purpose of this exploratory sequential mixed methods study was to describe the sources of informal financial support used by adolescent and young adult (AYA) cancer survivors and how financial toxicity and demographic factors were associated with different types and magnitudes of informal financial support. METHODS This analysis is part of a larger health insurance literacy study that included pre-trial interviews and a randomized controlled trial (RCT) for AYA cancer survivors. Eligible study participants were 18 years of age, diagnosed with cancer as an AYA (15-39 years), insured, and for the RCT sample less than 1 year from diagnosis. Interview audio was transcribed, quality checked, and thematically analyzed. RCT baseline and follow-up surveys captured informal financial support use. Chi-squared and Fisher's exact tests were used to assess differences in informal financial support type use and frequency by financial toxicity and AYA demographics. RESULTS A total of N = 24 and N = 86 AYAs participated in pre-trial interviews and the RCT respectively. Interview participants reported a variety of informal financial support sources including savings, community, family/friends, and fundraisers. However, only half of participants reported their informal financial support to be sufficient. High financial toxicity was associated with the most types of informal financial support and a higher magnitude of use. The lowest income group accessed informal financial supports less frequently than higher income groups. CONCLUSION Our study demonstrates that AYA survivors experiencing financial toxicity frequently turn to informal sources of financial support and the magnitude is associated with financial toxicity. However, low-income survivors, and other at-risk survivors, may not have access to informal sources of financial support potentially widening inequities.
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Affiliation(s)
- Austin R Waters
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA.
| | - Karely M van Thiel Berghuijs
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Heydon K Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Perla L Vaca Lopez
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Amy Chevrier
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Nicole Ray
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Tomoko Tsukamoto
- Intermountain Medical Oncology, Intermountain Healthcare, Murray, UT, USA
| | - Karlie Allen
- Patient and Public Education, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Douglas B Fair
- Deparment of Pediatrics, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Mark A Lewis
- Intermountain Medical Oncology, Intermountain Healthcare, Murray, UT, USA
| | - Giselle K Perez
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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14
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Grassi L, Fantaccini S. An overview of Fintech applications to solve the puzzle of health care funding: state-of-the-art in medical crowdfunding. FINANCIAL INNOVATION 2022; 8:84. [PMID: 36158456 PMCID: PMC9483272 DOI: 10.1186/s40854-022-00388-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Crowdfunding is emerging as an alternative form of funding for medical purposes, with capital being raised directly from a broader and more diverse audience of investors. In this paper, we have systematically researched and reviewed the literature on medical crowdfunding to determine how crowdfunding connects with the health care industry. The health care industry has been struggling to develop sustainable research and business models for economic systems and investors alike, especially in pharmaceuticals. The research results have revealed a wealth of evidence concerning the way crowdfunding is applied in real life. Patients and caregivers utilize web platform-based campaigns all over the world to fund their medical expenses, generally on a spot basis, using donation-based or even reward-based schemes, regardless of the health care system archetype (public, private insurance-based or hybrid). Academics have also focused on funding campaigns and the predictors of success (which range from social behaviour and environment to the basic demographics of the campaigners and their diseases) and on social and regulatory concerns, including heightened social inequality and stigma. While equity crowdfunding is disrupting the way many ventures/businesses seek capital in the market, our research indicates that there are no relevant or consistent data on the practice of medical equity crowdfunding in health care, apart from a few anecdotal cases.
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Affiliation(s)
- Laura Grassi
- School of Management, Politecnico di Milano, Milan, Italy
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15
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Doerstling SS, Akrobetu D, Engelhard MM, Chen F, Ubel PA. A Disease Identification Algorithm for Medical Crowdfunding Campaigns: Validation Study. J Med Internet Res 2022; 24:e32867. [PMID: 35727610 PMCID: PMC9257615 DOI: 10.2196/32867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/11/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Web-based crowdfunding has become a popular method to raise money for medical expenses, and there is growing research interest in this topic. However, crowdfunding data are largely composed of unstructured text, thereby posing many challenges for researchers hoping to answer questions about specific medical conditions. Previous studies have used methods that either failed to address major challenges or were poorly scalable to large sample sizes. To enable further research on this emerging funding mechanism in health care, better methods are needed. Objective We sought to validate an algorithm for identifying 11 disease categories in web-based medical crowdfunding campaigns. We hypothesized that a disease identification algorithm combining a named entity recognition (NER) model and word search approach could identify disease categories with high precision and accuracy. Such an algorithm would facilitate further research using these data. Methods Web scraping was used to collect data on medical crowdfunding campaigns from GoFundMe (GoFundMe Inc). Using pretrained NER and entity resolution models from Spark NLP for Healthcare in combination with targeted keyword searches, we constructed an algorithm to identify conditions in the campaign descriptions, translate conditions to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes, and predict the presence or absence of 11 disease categories in the campaigns. The classification performance of the algorithm was evaluated against 400 manually labeled campaigns. Results We collected data on 89,645 crowdfunding campaigns through web scraping. The interrater reliability for detecting the presence of broad disease categories in the campaign descriptions was high (Cohen κ: range 0.69-0.96). The NER and entity resolution models identified 6594 unique (276,020 total) ICD-10-CM codes among all of the crowdfunding campaigns in our sample. Through our word search, we identified 3261 additional campaigns for which a medical condition was not otherwise detected with the NER model. When averaged across all disease categories and weighted by the number of campaigns that mentioned each disease category, the algorithm demonstrated an overall precision of 0.83 (range 0.48-0.97), a recall of 0.77 (range 0.42-0.98), an F1 score of 0.78 (range 0.56-0.96), and an accuracy of 95% (range 90%-98%). Conclusions A disease identification algorithm combining pretrained natural language processing models and ICD-10-CM code–based disease categorization was able to detect 11 disease categories in medical crowdfunding campaigns with high precision and accuracy.
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Affiliation(s)
- Steven S Doerstling
- Duke University School of Medicine, Duke University, Durham, NC, United States.,Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Dennis Akrobetu
- Duke University School of Medicine, Duke University, Durham, NC, United States.,Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Matthew M Engelhard
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
| | | | - Peter A Ubel
- Fuqua School of Business, Duke University, Durham, NC, United States.,Sanford School of Public Policy, Duke University, Durham, NC, United States
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16
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Kenworthy N, Igra M. Medical Crowdfunding and Disparities in Health Care Access in the United States, 2016‒2020. Am J Public Health 2022; 112:491-498. [PMID: 35113726 PMCID: PMC8887155 DOI: 10.2105/ajph.2021.306617] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 01/29/2023]
Abstract
Objectives. To assess whether medical crowdfunding use and outcomes are aligned with health financing needs in the United States. Methods. We collected data on 437 596 US medical GoFundMe campaigns between 2016 and 2020. In addition to summarizing trends in campaign initiation and earnings, we used state- and county-level data to assess whether crowdfunding usage and earnings were higher in areas with greater medical debt, uninsured populations, and poverty. Results. Campaigns raised more than $2 billion from 21.7 million donations between 2016 and 2020. Returns were highly unequal, and success was low, especially in 2020: only 12% of campaigns met their goals, and 16% received no donations at all. Campaigns in 2020 raised substantially less money in areas with more medical debt, higher uninsurance rates, and lower incomes. Conclusions. Despite its popularity and portrayals as an ad-hoc safety net, medical crowdfunding is misaligned with key indicators of health financing needs in the United States. It is best positioned to help in populations that need it the least. (Am J Public Health. 2022;112(3):491-498. https://doi.org/10.2105/AJPH.2021.306617).
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Affiliation(s)
- Nora Kenworthy
- Nora Kenworthy is with the School of Nursing and Health Studies, University of Washington, Bothell. Mark Igra is with the Department of Sociology, University of Washington, Seattle
| | - Mark Igra
- Nora Kenworthy is with the School of Nursing and Health Studies, University of Washington, Bothell. Mark Igra is with the Department of Sociology, University of Washington, Seattle
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17
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Livingstone A, Servais L, Wilkinson DJC. Crowdfunding for neuromuscular disease treatment: the ethical implications. Lancet Neurol 2021; 20:788-789. [PMID: 34536401 DOI: 10.1016/s1474-4422(21)00266-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/05/2021] [Indexed: 12/01/2022]
Affiliation(s)
| | - Laurent Servais
- MDUK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, UK; Division of Child Neurology Reference Center for Neuromuscular Disease, Department of Paediatrics, University Hospital Liège, Liège, Belgium
| | - Dominic J C Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK; Newborn Care Unit, John Radcliffe Hospital, Oxford OX1 1PT, UK; Murdoch Children's Research Institute, Melbourne, VIC, Australia.
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18
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Thomas HS, Lee AW, Nabavizadeh B, Namiri NK, Hakam N, Martin-Tuite P, Rios N, Enriquez A, Mmonu NA, Cohen AJ, Breyer BN. Characterizing online crowdfunding campaigns for patients with kidney cancer. Cancer Med 2021; 10:4564-4574. [PMID: 34102000 PMCID: PMC8267118 DOI: 10.1002/cam4.3974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/16/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cancer patients incur high care costs; however, there is a paucity of literature characterizing unmet financial obligations for patients with urologic cancers. Kidney cancer patients are particularly burdened by costs associated with novel systemic treatments. This study aimed to ascertain the characteristics of GoFundMe® crowdfunding campaigns for patients with kidney cancer, in order to better understand the financial needs of this population. Methods We performed a cross‐sectional, quantitative, and qualitative analysis of all kidney cancer GoFundMe® campaigns since 2010. Fundraising metrics such as goal funds and amount raised, were extracted. Eight independent investigators collected patient, disease and campaign‐level variables from campaign stories (κ = 0.72). In addition, we performed a content analysis of campaign narratives spotlighting the primary appeal of the patient's life story. Results A total of 486 GoFundMe® kidney cancer campaigns were reviewed. The median goal funds were 10,000USD [IQR = 5000, 20,000] and the median amount raised was 1450USD [IQR = 578, 4050]. Most campaigns were for adult males (53%) and 62% of adults had children. A minority were for pediatric patients (17%). Thirty‐seven percent of adult patients were primary wage earners and 43% reported losing their job or substantially reducing hours due to illness. Twenty‐nine percent reported no insurance or insufficient coverage. Campaigns most frequently sought funds for medical bills (60%), nonmedical bills (27%), and medical travel (23%). Qualitative campaign narratives mostly emphasized patients’ hardship (46.3%) or high moral character (35.2%). Only 8% of campaigns achieved their target funds. Conclusions Despite fundraising efforts, patients with kidney cancer face persistent financial barriers, incurring both medical and nonmedical cost burdens. This may be compounded by limited or no insurance. Cancer care providers should be aware of financial constraints placed on kidney cancer patients, and consider how these may impact treatment regimens.
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Affiliation(s)
- Hannah S Thomas
- University of Edinburgh School of Medicine, Edinburgh, UK.,Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Austin W Lee
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Behnam Nabavizadeh
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Nikan K Namiri
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Nizar Hakam
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Patrick Martin-Tuite
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Natalie Rios
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Anthony Enriquez
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Nnenaya A Mmonu
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Andrew J Cohen
- The Brady Urological Institute at Johns Hopkins, Baltimore, MD, USA
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA.,Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA, USA
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19
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Saleh SN, Lehmann CU, Medford RJ. Early Crowdfunding Response to the COVID-19 Pandemic: Cross-sectional Study. J Med Internet Res 2021; 23:e25429. [PMID: 33523826 PMCID: PMC7879716 DOI: 10.2196/25429] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/23/2020] [Accepted: 01/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background As the number of COVID-19 cases increased precipitously in the United States, policy makers and health officials marshalled their pandemic responses. As the economic impacts multiplied, anecdotal reports noted the increased use of web-based crowdfunding to defray these costs. Objective We examined the web-based crowdfunding response in the early stage of the COVID-19 pandemic in the United States to understand the incidence of initiation of COVID-19–related campaigns and compare them to non–COVID-19–related campaigns. Methods On May 16, 2020, we extracted all available data available on US campaigns that contained narratives and were created between January 1 and May 10, 2020, on GoFundMe. We identified the subset of COVID-19–related campaigns using keywords relevant to the COVID-19 pandemic. We explored the incidence of COVID-19–related campaigns by geography, by category, and over time, and we compared the characteristics of the campaigns to those of non–COVID-19–related campaigns after March 11, when the pandemic was declared. We then used a natural language processing algorithm to cluster campaigns by narrative content using overlapping keywords. Results We found that there was a substantial increase in overall GoFundMe web-based crowdfunding campaigns in March, largely attributable to COVID-19–related campaigns. However, as the COVID-19 pandemic persisted and progressed, the number of campaigns per COVID-19 case declined more than tenfold across all states. The states with the earliest disease burden had the fewest campaigns per case, indicating a lack of a case-dependent response. COVID-19–related campaigns raised more money, had a longer narrative description, and were more likely to be shared on Facebook than other campaigns in the study period. Conclusions Web-based crowdfunding appears to be a stopgap for only a minority of campaigners. The novelty of an emergency likely impacts both campaign initiation and crowdfunding success, as it reflects the affective response of a community. Crowdfunding activity likely serves as an early signal for emerging needs and societal sentiment for communities in acute distress that could be used by governments and aid organizations to guide disaster relief and policy.
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Affiliation(s)
- Sameh Nagui Saleh
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Departments of Pediatrics, Bioinformatics, Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Richard J Medford
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
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20
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Affiliation(s)
- S Yousuf Zafar
- Duke Cancer Institute, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Durham, North Carolina
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21
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Silver ER, Truong HQ, Ostvar S, Hur C, Tatonetti NP. Association of Neighborhood Deprivation Index With Success in Cancer Care Crowdfunding. JAMA Netw Open 2020; 3:e2026946. [PMID: 33270122 PMCID: PMC7716189 DOI: 10.1001/jamanetworkopen.2020.26946] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/25/2020] [Indexed: 01/16/2023] Open
Abstract
Importance Financial toxicity resulting from cancer care poses a substantial public health concern, leading some patients to turn to online crowdfunding. However, the practice may exacerbate existing socioeconomic cancer disparities by privileging those with access to interpersonal wealth and digital media literacy. Objective To test the hypotheses that higher county-level socioeconomic status and the presence (vs absence) of text indicators of beneficiary worth in campaign descriptions are associated with amount raised from cancer crowdfunding. Design, Setting, and Participants This cross-sectional analysis examined US cancer crowdfunding campaigns conducted between 2010 and 2019 and data from the American Community Survey (2013-2017). Data analysis was performed from December 2019 to March 2020. Exposures Neighborhood deprivation index of campaign location and campaign text features indicating the beneficiary's worth. Main Outcomes and Measures Amount of money raised. Results This study analyzed 144 061 US cancer crowdfunding campaigns. Campaigns in counties with higher neighborhood deprivation raised less (-26.07%; 95% CI, -27.46% to -24.65%; P < .001) than those in counties with less neighborhood deprivation. Campaigns raised more funds when legitimizing details were provided, including clinical details about the cancer type (9.58%; 95% CI, 8.00% to 11.18%; P < .001) and treatment type (6.58%; 95% CI, 5.44% to 7.79%; P < .001) and financial details, such as insurance status (1.39%; 95% CI, 0.20% to 2.63%; P = .02) and out-of-pocket costs (7.36%; 95% CI, 6.18% to 8.55%; P < .001). Campaigns raised more money when beneficiaries were described as warm (13.80%; 95% CI, 12.30% to 15.26%; P < .001), brave (15.40%; 95% CI, 14.11% to 16.65%; P < .001), or self-reliant (5.23%; 95% CI, 3.77% to 6.72%; P < .001). Conclusions and Relevance These findings suggest that cancer crowdfunding success ay disproportionately benefit those in high-socioeconomic status areas and those with the internet literacy necessary to portray beneficiaries as worthy. By rewarding those with existing socioeconomic advantage, cancer crowdfunding may perpetuate socioeconomic disparities in cancer care access. The findings also underscore the widespread nature of financial toxicity resulting from cancer care.
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Affiliation(s)
- Elisabeth R. Silver
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Han Q. Truong
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sassan Ostvar
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Chin Hur
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Nicholas P. Tatonetti
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
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