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Lim M, Bohorquez NG, Mitchell R, Cramb S, Bradford N, Naicker S, Kularatna S, Senanayake S. Financial Aid in Children, Adolescents and Young Adult's Cancer Care: A Scoping Review. J Adolesc Young Adult Oncol 2024; 13:583-596. [PMID: 38451723 DOI: 10.1089/jayao.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background: The financial burden resulting from cancers on families is higher when it arises in young people compared with older adults. Previous research has provided insight into the financial toxicities associated with childhood cancer, but less is known about the efficacy of financial aid systems in reducing the financial burden on families. We conducted a scoping review to identify the determinants of success and failure of financial aid. Methods: Five databases were searched for articles published between January 1, 2000 and December 1, 2022. Dual processes were used to screen and select studies. Through thematic content analysis, we identified barriers and enablers of financial aid, categorised by country income level. Results: From 17 articles, which were evenly split between high-income countries and upper middle- to low-income countries, four major themes emerged: (1) accessibility of support, (2) delivery of support, (3) administration, and (4) psychosocial factors. Within these themes, the enablers identified were (1) support navigators, (2) establishing a direct contact between donors and beneficiaries, (3) implementation of digital solutions to improve outreach, and (4) using cultural and community values to encourage donor engagement. Conclusions: This scoping review identified the determinants of success and failure of financial aid in supporting families in the context of childhood, adolescent, and young adult (CAYA) cancers. By understanding the barriers and enablers identified in this review, organizations could develop pragmatic evidence-based care models and policies to ensure access to assistance is equitable and appropriate for families experiencing CAYA cancers.
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Affiliation(s)
- Megumi Lim
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Natalia Gonzalez Bohorquez
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Remai Mitchell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Susanna Cramb
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre at the Centre for Children's Health Research, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Sundresan Naicker
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
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Wood TF, Murphy RA. Combattre la toxicité financière associée aux soins contre le cancer au Canada. CMAJ 2024; 196:E612-E614. [PMID: 38719219 PMCID: PMC11073827 DOI: 10.1503/cmaj.230677-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Affiliation(s)
- Truman F Wood
- École de santé publique (Wood, Murphy), Université de la Colombie-Britannique; Service de recherche sur la lutte contre le cancer (Cancer Control Research) (Murphy), Institut de recherche sur le cancer de la Colombie-Britannique, Vancouver, C.-B
| | - Rachel A Murphy
- École de santé publique (Wood, Murphy), Université de la Colombie-Britannique; Service de recherche sur la lutte contre le cancer (Cancer Control Research) (Murphy), Institut de recherche sur le cancer de la Colombie-Britannique, Vancouver, C.-B.
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Wood TF, Murphy RA. Tackling financial toxicity related to cancer care in Canada. CMAJ 2024; 196:E297-E298. [PMID: 38467415 PMCID: PMC10927292 DOI: 10.1503/cmaj.230677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Affiliation(s)
- Truman F Wood
- School of Population and Public Health (Wood, Murphy), University of British Columbia; Cancer Control Research (Murphy), BC Cancer Research Institute, Vancouver, BC
| | - Rachel A Murphy
- School of Population and Public Health (Wood, Murphy), University of British Columbia; Cancer Control Research (Murphy), BC Cancer Research Institute, Vancouver, BC
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Reece S, Moss RH, Tanveer Z, Hammad M, Pickett KE, Dickerson J. Exploring the feasibility of evaluating a community alliance welfare advice programme co-located in primary care in Bradford: an uncontrolled before and after study. BMC Public Health 2024; 24:300. [PMID: 38273264 PMCID: PMC10811861 DOI: 10.1186/s12889-024-17773-x] [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: 08/25/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Welfare advice services co-located in health settings are known to improve financial security. However, little is known on how to effectively evaluate these services. This study aims to explore the feasibility of evaluating a welfare advice service co-located in a primary care setting in a deprived and ethnically diverse population. It seeks to investigate whether the proposed evaluation tools and processes are acceptable and feasible to implement and whether they are able to detect any evidence of promise for this intervention on the mental health, wellbeing and financial security of participants. METHODS An uncontrolled before and after study design was utilised. Data on mental health, wellbeing, quality of life and financial outcomes were collected at baseline prior to receiving welfare advice and at three months follow-up. Multiple logistic and linear regression models were used to explore individual differences in self-reported financial security and changes to mental health, wellbeing and quality of life scores before and after the provision of welfare advice. RESULTS Overall, the majority of key outcome measures were well completed, indicating participant acceptability of the mental health, wellbeing, quality of life and financial outcome measures used in this population. There was evidence suggestive of an improvement in participant financial security and evidence of promise for improvements in measured wellbeing and health-related quality of life for participants accessing services in a highly ethnically diverse population. Overall, the VCS Alliance welfare advice programme generated a total of £21,823.05 for all participants, with participants gaining an average of £389.70 per participant for participants with complete financial outcome data. CONCLUSIONS This research demonstrates the feasibility of evaluating a welfare advice service co-located in primary care in a deprived and ethnically diverse setting utilising the ascribed mental health, wellbeing and quality of life and financial outcome tools. It provides evidence of promise to support the hypothesis that the implementation of a welfare advice service co-located in a health setting can improve health and wellbeing and reduce health inequalities.
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Affiliation(s)
- Sian Reece
- Hull York Medical School, York, North Yorkshire, UK.
| | - Rachael H Moss
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, UK
| | - Zahrah Tanveer
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, UK
| | - Mohammed Hammad
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, UK
| | - Kate E Pickett
- Department of Health Sciences, University of York, Heslington Road, York, North Yorkshire, UK
| | - Josie Dickerson
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, UK
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Ngan TT, Tien TH, Donnelly M, O’Neill C. Financial toxicity among cancer patients, survivors and their families in the United Kingdom: a scoping review. J Public Health (Oxf) 2023; 45:e702-e713. [PMID: 37541834 PMCID: PMC10687873 DOI: 10.1093/pubmed/fdad143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND The aim of this scoping review was to identify key research gaps and priorities in order to advance policy and practice for people living with cancer in the UK. METHODS The review adhered to PRISMA guidelines for scoping review. We searched MEDLINE, EMBASE, Scopus, Web of Science and Google Scholar on 16 July 2022. There were no restrictions in terms of study design and publication time; gray literature was included. The key words, 'financial' or 'economic', were combined with each of the following words 'hardship/stress/burden/distress/strain/toxicity/catastrophe/consequence/impact.' RESULTS 29/629 studies/reports published during 1982-2022 were eligible to be included in the review. No study conducted a comprehensive inquiry and reported all aspects of financial toxicity (FT) or used a validated measure of FT. The most three commonly reported outcomes related to financial hardship were financial well-being (24/29), benefit/welfare (17/29) and mental health status (16/29). CONCLUSIONS It is evident that FT is experienced by UK cancer patients/survivors and that the issue is under-researched. There is an urgent need for further research including rigorous studies which contribute to a comprehensive understanding about the nature and extent of FT, disparities in experience, the impacts of FT on outcomes and potential solutions to alleviate FT and related problems.
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Affiliation(s)
- Tran T Ngan
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Tran H Tien
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Korea
- Department of Pharmacy, University Medical Center Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Michael Donnelly
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Ciaran O’Neill
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
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Nicoli I, Lockwood G, Fitch L, Longo CJ, Fitch MI. Impact of Income on Physical Concerns, Help Seeking, and Unmet Needs of Adult Cancer Survivors. Physiother Can 2023; 75:339-347. [PMID: 38037576 PMCID: PMC10686300 DOI: 10.3138/ptc-2021-0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/29/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2023]
Abstract
Purpose Cancer treatment can have consequences for individuals which may have profound impact on daily living. Accessing assistance can be problematic. This study explores associations between income and concerns, help-seeking, and unmet needs related to physical changes following cancer treatment. Method A national survey was conducted with cancer survivors about experiences with follow-up care one to three years after treatment. We report a trend analysis describing associations between income and cancer survivors' concerns, help-seeking, and unmet needs related to physical changes after treatment. Results In total 5,283 cancer survivors between 18 and 64 years responded, of which 4,264 (80.7%) indicated annual household income. The majority of respondents were survivors of breast (34.4%), colorectal (15.0%), and prostate (14.0%) cancers. Over 90% wrote about experiencing physical changes following cancer treatment. Survivors with low annual household incomes of less than $25,000 (CAN) reported the highest levels of concern about multiple physical changes and were more likely to seek help to address them. Conclusions Cancer survivors can experience various physical challenges and unmet needs following cancer treatment and difficulty obtaining relevant help across all income levels. Those with low income are more severely affected. Financial assessment and tailored follow-up are recommended.
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Affiliation(s)
- Irene Nicoli
- From the:
From the: Health Care Independent Consultant, Toronto, Ontario, Canada
| | - Gina Lockwood
- Biostatistician Independent Consultant, Toronto, Ontario, Canada
| | - Lauren Fitch
- Davidson Physiotherapy, Riverview, New Brunswick, Canada
| | - Christopher J. Longo
- Associate Health Policy and Management, De Groote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Margaret I. Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Chung H, Hyatt A, Kosmider S, Webber K, Krishnasamy M. Availability and accessibility of services to address financial toxicity described by Australian lung cancer patients and healthcare professionals. Support Care Cancer 2023; 31:554. [PMID: 37659009 PMCID: PMC10474978 DOI: 10.1007/s00520-023-08019-4] [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: 05/10/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Although the financial burden and impact of a cancer diagnosis has been widely described in international literature, less understood is the availability and accessibility of services to ameliorate this need. This study reports the experiences of Australian lung cancer patients and health professionals delivering care, regarding factors that exacerbate and mitigate financial stress, and availability and accessibility of services to support people following a cancer diagnosis. METHODS Qualitative semi-structured interviews with twenty-three lung cancer patients attending two metropolitan tertiary health services and eleven health professionals delivering care were undertaken during July-August 2021. RESULTS Neither health service systematically screened for financial toxicity nor routinely provided information regarding potential financial impacts during consultations. Patients experienced lengthy delays in accessing welfare supports, provoking financial stress and worry. Health professionals reported limited resources and referral services to support patients with financial need; this was especially problematic for patients with lung cancer. They described its psychological impact on patients and their family members or carers and warned of its impact on ability to adhere to treatment. CONCLUSION Available and accessibility of services addressing financial toxicity in Australian lung cancer patients is inadequate. Although financial stress is a common, distressing problem, health professionals feel hampered in their ability to help due to limited service availability. Left unaddressed, financial toxicity can impact treatment adherence, directly influencing health outcomes, and increase risk of poverty, amplifying social inequities. Findings highlight opportunity for actionable interventions like financial consent and routine screening and discussion of financial toxicity across care pathways.
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Affiliation(s)
- Holly Chung
- Academic Nursing Unit, Peter MacCallum Cancer Centre, 305 Grattan Street Parkville, Melbourne, Victoria, 3000, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, 305 Grattan Street Parkville, Melbourne, Victoria, 3000, Australia
| | - Amelia Hyatt
- Department of Health Services Research, Peter MacCallum Cancer Centre, 305 Grattan Street Parkville, Melbourne, Victoria, 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, 3010, Australia
- Department of Nursing, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Suzanne Kosmider
- Cancer Services, Sunshine Hospital, Western Health, St Albans, Victoria, 3021, Australia
| | - Kate Webber
- Oncology Department, Monash Health, Clayton, Victoria, 3168, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, 3800, Australia
| | - Meinir Krishnasamy
- Academic Nursing Unit, Peter MacCallum Cancer Centre, 305 Grattan Street Parkville, Melbourne, Victoria, 3000, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, 3010, Australia.
- Department of Nursing, University of Melbourne, Melbourne, Victoria, 3010, Australia.
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Victoria, 3000, Australia.
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Zvolensky MJ, Heggeness LF, Mayorga N, Garey L, Buckner JD, Businelle MS, Redmond BY. Financial Strain Among Black Smokers in Terms of Abstinence Expectancies. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01720-4. [PMID: 37488316 DOI: 10.1007/s40615-023-01720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA.
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, USA.
- HEALTH Institute, University of Houston, Houston, USA.
| | - Luke F Heggeness
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Nubia Mayorga
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
- HEALTH Institute, University of Houston, Houston, USA
| | - Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, USA
| | - Michael S Businelle
- HEALTH Institute, University of Houston, Houston, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma, OK, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Brooke Y Redmond
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
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Yoshino CA, Sidney-Annerstedt K, Wingfield T, Kirubi B, Viney K, Boccia D, Atkins S. Experiences of conditional and unconditional cash transfers intended for improving health outcomes and health service use: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 3:CD013635. [PMID: 36999604 PMCID: PMC10064639 DOI: 10.1002/14651858.cd013635.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND It is well known that poverty is associated with ill health and that ill health can result in direct and indirect costs that can perpetuate poverty. Social protection, which includes policies and programmes intended to prevent and reduce poverty in times of ill health, could be one way to break this vicious cycle. Social protection, particularly cash transfers, also has the potential to promote healthier behaviours, including healthcare seeking. Although social protection, particularly conditional and unconditional cash transfers, has been widely studied, it is not well known how recipients experience social protection interventions, and what unintended effects such interventions can cause. OBJECTIVES: The aim of this review was to explore how conditional and unconditional cash transfer social protection interventions with a health outcome are experienced and perceived by their recipients. SEARCH METHODS: We searched Epistemonikos, MEDLINE, CINAHL, Social Services Abstracts, Global Index Medicus, Scopus, AnthroSource and EconLit from the start of the database to 5 June 2020. We combined this with reference checking, citation searching, grey literature and contact with authors to identify additional studies. We reran all strategies in July 2022, and the new studies are awaiting classification. SELECTION CRITERIA We included primary studies, using qualitative methods or mixed-methods studies with qualitative research reporting on recipients' experiences of cash transfer interventions where health outcomes were evaluated. Recipients could be adult patients of healthcare services, the general adult population as recipients of cash targeted at themselves or directed at children. Studies could be evaluated on any mental or physical health condition or cash transfer mechanism. Studies could come from any country and be in any language. Two authors independently selected studies. DATA COLLECTION AND ANALYSIS: We used a multi-step purposive sampling framework for selecting studies, starting with geographical representation, followed by health condition, and richness of data. Key data were extracted by the authors into Excel. Methodological limitations were assessed independently using the Critical Appraisal Skills Programme (CASP) criteria by two authors. Data were synthesised using meta-ethnography, and confidence in findings was assessed using the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. MAIN RESULTS: We included 127 studies in the review and sampled 41 of these studies for our analysis. Thirty-two further studies were found after the updated search on 5 July 2022 and are awaiting classification. The sampled studies were from 24 different countries: 17 studies were from the African region, seven were from the region of the Americas, seven were from the European region, six were from the South-East Asian region, three from the Western Pacific region and one study was multiregional, covering both the African and the Eastern Mediterranean regions. These studies primarily explored the views and experiences of cash transfer recipients with different health conditions, such as infectious diseases, disabilities and long-term illnesses, sexual and reproductive health, and maternal and child health. Our GRADE-CERQual assessment indicated we had mainly moderate- and high-confidence findings. We found that recipients perceived the cash transfers as necessary and helpful for immediate needs and, in some cases, helpful for longer-term benefits. However, across conditional and unconditional programmes, recipients often felt that the amount given was too little in relation to their total needs. They also felt that the cash alone was not enough to change their behaviour and, to change behaviour, additional types of support would be required. The cash transfer was reported to have important effects on empowerment, autonomy and agency, but also in some settings, recipients experienced pressure from family or programme staff on cash usage. The cash transfer was reported to improve social cohesion and reduce intrahousehold tension. However, in settings where some received the cash and others did not, the lack of an equal approach caused tension, suspicion and conflict. Recipients also reported stigma in terms of cash transfer programme assessment processes and eligibility, as well as inappropriate eligibility processes. Across settings, recipients experienced barriers in accessing the cash transfer programme, and some refused or were hesitant to receive the cash. Some recipients found cash transfer programmes more acceptable when they agreed with the programme's goals and processes. AUTHORS' CONCLUSIONS: Our findings highlight the impact of the sociocultural context on the functioning and interaction between the individual, family and cash transfer programmes. Even where the goals of a cash transfer programme are explicitly health-related, the outcomes may be far broader than health alone and may include, for example, reduced stigma, empowerment and increased agency of the individual. When measuring programme outcomes, therefore, these broader impacts could be considered for understanding the health and well-being benefits of cash transfers.
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Affiliation(s)
- Clara A Yoshino
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kristi Sidney-Annerstedt
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tom Wingfield
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Clinical Infection, Microbiology, and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Beatrice Kirubi
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Public Health Research (CPHR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Kerri Viney
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Research School of Population Health, Australian National University, Canberra, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Delia Boccia
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Salla Atkins
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Global Health and Development, Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
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Young D, Bates G. Maximising the health impacts of free advice services in the UK: A mixed methods systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1713-1725. [PMID: 35307896 PMCID: PMC9545623 DOI: 10.1111/hsc.13777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/28/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
After a decade of austerity spending cuts and welfare reform, the COVID-19 pandemic has posed further challenges to the finances, health and wellbeing of working-age, low-income people. While advice services have been widely seen (and funded) as an income maximisation intervention, their health and well-being impact is less clear. Previous systematic reviews investigating the link between advice services and health outcomes have found a weak evidence base and cover the period up until 2010. This mixed methods review examined up to date evidence to help understand the health impacts of free and independent welfare rights advice services. We included evaluations of free to access advice services on social welfare issues for members of the public that included health outcomes. Through comprehensive searches of two bibliographic databases and websites of relevant organisations we identified 15 articles based on a mixture of study designs. The advice interventions evaluated were based in a range of settings and only limited information was available on the delivery and nature of advice offered. We undertook a convergent synthesis to analyse data on the effectiveness of advice services on health outcomes and to explain variation in these outcomes. Our synthesis suggested that improvements in mental health and well-being measures are commonly attributed to advice service interventions. However, there is little insight to explain these impacts or to inform the delivery of services that maximise health benefits. Co-locating services in health settings appears promising and embracing models of delivery that promote collaboration between organisations tackling the social determinants of health may help to address the inherent complexities in the delivery of advice services and client needs. We make recommendations to improve routine monitoring and reporting by advice services, and methods of evaluation that will better account for complexity and context.
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Affiliation(s)
- David Young
- Sustainable Housing and Urban Studies Unit (SHUSU)University of SalfordSalfordUK
| | - Geoff Bates
- Institute for Policy ResearchUniversity of BathBathUK
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Parker C, Berkovic D, Ayton D, Zomer E, Liew D, Wei A. Patient Perceived Financial Burden in Haematological Malignancies: A Systematic Review. Curr Oncol 2022; 29:3807-3824. [PMID: 35735414 PMCID: PMC9221876 DOI: 10.3390/curroncol29060305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 12/19/2022] Open
Abstract
Advances in scientific understanding have led to novel therapies and improved supportive care for many patients with haematological malignancies. However, these new drugs are often costly, only available at centralised health care facilities, require regular specialist reviews and lengthy treatment regimens. This leads to a significant financial burden. Understanding the impact of financial burden on haematological patients is important to appreciate the urgency of alleviating this systemic issue. Method: Eligible studies were identified by systematically searching Medline, PsycINFO, CINAHL and Embase. Self-reported data reported in both quantitative and qualitative studies that described the financial burden for patients with haematological malignancies were included. Quality appraisal of the included studies was undertaken using the Joanna Briggs Institute tools. A narrative synthesis was employed. For quantitative studies, outcomes were extracted, tabulated and categorised to find similarities and differences between the studies. For qualitative studies, quotations, codes and themes were extracted and then clustered. An inductive approach derived qualitative themes. Results: Twenty studies were identified for inclusion. Of the quantitative studies most (83%) employed un-validated researcher-generated measures to assess financial burden. Between 15–59% of patients experienced a financial burden. Out-of-pocket expenditure was frequent for clinical appointments, prescription and non-prescription medication, and travel. Financial burden was associated with a worsening quality of life and living in metropolitan areas, but there was no evidence for impact on survival. Patient-centred experiences from the qualitative inquiry complemented the quantitative findings and five themes were determined: familial or household impact; reliance on others; barriers to care due to cost; and barriers to accessing financial assistance and sources of out-of-pocket expenses. Conclusion: The impacts of financial burden are yet to be fully appreciated in haematological malignancies, exacerbated by the heterogeneous methods employed by researchers. Future work should focus on identifying the long-term ramifications of financial burden for patients and should trial interventions to reduce its prevalence and patient impacts.
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Affiliation(s)
- Catriona Parker
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (D.B.); (D.A.); (E.Z.); (D.L.)
- Department of Haematology, Alfred Health, Melbourne 3004, Australia;
- Correspondence:
| | - Danielle Berkovic
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (D.B.); (D.A.); (E.Z.); (D.L.)
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (D.B.); (D.A.); (E.Z.); (D.L.)
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (D.B.); (D.A.); (E.Z.); (D.L.)
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (D.B.); (D.A.); (E.Z.); (D.L.)
| | - Andrew Wei
- Department of Haematology, Alfred Health, Melbourne 3004, Australia;
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Routinely asking patients about income in primary care: a mixed-methods study. BJGP Open 2021; 6:BJGPO.2021.0090. [PMID: 34666982 PMCID: PMC8958735 DOI: 10.3399/bjgpo.2021.0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background Income is a key social determinant of health, yet it is rare for data on income to be routinely collected and integrated with electronic health records. Aim To examine response bias and evaluate patient perspectives of being asked about income in primary care. Design & setting Mixed-methods study in a large, multi-site primary care organisation in Toronto, Canada, where patients are asked about income in a routinely administered sociodemographic survey. Method Data were examined from the electronic health records of patients who answered at least one question on the survey between December 2013 and March 2016 (n = 14 247). The study compared those who responded to the income question with non-responders. Structured interviews with 27 patients were also conducted. Results A total of 10 441 (73%) patients responded to both parts of the income question: ‘What was your total family income before taxes last year?’ and ‘How many people does your income support?’. Female patients, ethnic minorities, caregivers of young children, and older people were less likely to respond. From interviews, many patients were comfortable answering the income question, particularly if they understood the connection between income and health, and believed the data would be used to improve care. Several patients found it difficult to estimate their income or felt the options did not reflect fluctuating financial circumstances. Conclusion Many patients will provide data on income in the context of a survey in primary care, but accurately estimating income can be challenging. Future research should compare self-reported income to perceived financial strain. Data on income linked to health records can help identify health inequities and help target anti-poverty interventions.
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Pauge S, Surmann B, Mehlis K, Zueger A, Richter L, Menold N, Greiner W, Winkler EC. Patient-Reported Financial Distress in Cancer: A Systematic Review of Risk Factors in Universal Healthcare Systems. Cancers (Basel) 2021; 13:cancers13195015. [PMID: 34638499 PMCID: PMC8508394 DOI: 10.3390/cancers13195015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary A comprehensive understanding of risk factors associated with experiencing subjective financial distress is needed to inform the development of valid instruments and effective interventions to tackle financial toxicity. Several studies from the US indicate a strong correlation of the US-healthcare system’s systematic organisation and its particular socioeconomic risk factors for cancer patients experiencing financial toxicity. It is assumed that risk factors differ in other high-income countries due to the different structure of universal healthcare coverage. As an exhaustive analysis for other countries is lacking, this review aims to identify risk factors for subjective financial distress in universal healthcare systems. Abstract Financial toxicity is a side effect of cancer that results from the perceived financial distress an individual may experience in the course of the disease. The purpose of this paper is to analyse underlying factors related to subjective financial distress in high-income countries with universal healthcare coverage. A systematic literature review was conducted to identify qualitative and quantitative studies of cancer patient-reported subjective financial distress by performing a search in the databases of PubMed, PsycINFO and CINAHL up to December 2020. A qualitative synthesis was performed linking the time-dependent occurrence of risk factors to derived categories of risk factors. Out of 4321 identified records, 30 quantitative and 16 qualitative studies were eligible. Classification of risk factors resulted in eight categories with a total of 34 subcategories. Subjective financial distress is primarily determined by pre-diagnosis sociodemographic- factors as well as financial and work factors that might change during the course of the disease. The design of healthcare and social security systems shapes the country-specific degree of subjective financial distress. Further research should focus on evolving multidisciplinary intervention schemes and multidimensional instruments for subjective financial distress to account for identified risk factors in universal healthcare systems more precisely.
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Affiliation(s)
- Sophie Pauge
- Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany; (B.S.); (W.G.)
- Correspondence: ; Tel.: +49-521-106-4331
| | - Bastian Surmann
- Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany; (B.S.); (W.G.)
| | - Katja Mehlis
- Section of Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.); (A.Z.); (E.C.W.)
| | - Andrea Zueger
- Section of Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.); (A.Z.); (E.C.W.)
| | - Luise Richter
- Methods in Empirical Social Research, Institute of Sociology, Faculty of Arts, Humanities and Social Science, Dresden University, 01062 Dresden, Germany; (L.R.); (N.M.)
| | - Natalja Menold
- Methods in Empirical Social Research, Institute of Sociology, Faculty of Arts, Humanities and Social Science, Dresden University, 01062 Dresden, Germany; (L.R.); (N.M.)
| | - Wolfgang Greiner
- Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany; (B.S.); (W.G.)
| | - Eva C. Winkler
- Section of Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.); (A.Z.); (E.C.W.)
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Santos BDD, Marques-Camargo AR, Pan R, Reis SMGD, Andrade RC, Neris RR, Nascimento LC. Family knowledge about the legal rights of children and adolescents with cancer. Rev Bras Enferm 2021; 74:e20200725. [PMID: 34133671 DOI: 10.1590/0034-7167-2020-0725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/09/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Identify the knowledge of family members of children and adolescents with cancer about their legal rights, difficulties, and concessions to ensure them. METHOD Quantitative study, survey type, of intersectional design. A questionnaire drawn up by the researchers was applied in order to characterize the minor and their family and also to identify the family's knowledge about legal rights. Descriptive statistics were used to analyze data. RESULTS 61 family members who participated know some more rights to the detriment of others and are especially motivated to search for information when negative impacts on the financial life increase, with repercussions beyond family health. CONCLUSION the studied population requires more information and demands knowledge about some rights guaranteed by law. Guidance on rights empowers the family and guarantees the necessary care, searching to have an intersectoral action qualify care and assist in restructuring family dynamics to deal with chronic conditions.
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Affiliation(s)
| | | | - Raquel Pan
- Universidade Federal do Triângulo Mineiro. Uberaba, Minas Gerais, Brazil
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Beardon S, Woodhead C, Cooper S, Ingram E, Genn H, Raine R. International Evidence on the Impact of Health-Justice Partnerships: A Systematic Scoping Review. Public Health Rev 2021; 42:1603976. [PMID: 34168897 PMCID: PMC8113986 DOI: 10.3389/phrs.2021.1603976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Health-justice partnerships (HJPs) are collaborations between healthcare and legal services which support patients with social welfare issues such as welfare benefits, debt, housing, education and employment. HJPs exist across the world in a variety of forms and with diverse objectives. This review synthesizes the international evidence on the impacts of HJPs. Methods: A systematic scoping review of international literature was undertaken. A wide-ranging search was conducted across academic databases and grey literature sources, covering OECD countries from January 1995 to December 2018. Data from included publications were extracted and research quality was assessed. A narrative synthesis approach was used to analyze and present the results. Results: Reported objectives of HJPs related to: prevention of health and legal problems; access to legal assistance; health improvement; resolution of legal problems; improvement of patient care; support for healthcare services; addressing inequalities; and catalyzing systemic change. There is strong evidence that HJPs: improve access to legal assistance for people at risk of social and health disadvantage; positively influence material and social circumstances through resolution of legal problems; and improve mental wellbeing. A wide range of other positive impacts were identified for individuals, services and communities; the strength of evidence for each is summarized and discussed. Conclusion: HJPs are effective in tackling social welfare issues that affect the health of disadvantaged groups in society and can therefore form a key part of public health strategies to address inequalities.
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Affiliation(s)
- Sarah Beardon
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Charlotte Woodhead
- Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Silvie Cooper
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Elizabeth Ingram
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Hazel Genn
- Faculty of Laws, University College London, London, United Kingdom
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, United Kingdom
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Experiencing financial toxicity associated with cancer in publicly funded healthcare systems: a systematic review of qualitative studies. J Cancer Surviv 2021; 16:314-328. [DOI: 10.1007/s11764-021-01025-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/07/2021] [Indexed: 11/26/2022]
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Pinto AD, Da Ponte M, Bondy M, Craig-Neil A, Murphy K, Ahmed S, Nair P, Swartz A, Green S. Addressing financial strain through a peer-to-peer intervention in primary care. Fam Pract 2020; 37:815-820. [PMID: 32537646 DOI: 10.1093/fampra/cmaa046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Financial strain is a key social determinant of health. As primary care organizations begin to explore ways to address social determinants, peer-to-peer interventions hold promise. OBJECTIVE Our objective was to evaluate a peer-to-peer intervention focussed on financial empowerment delivered in primary care, in partnership with a social enterprise. METHODS This intervention was hosted by a large primary care organization in Toronto, Canada. Participants were recruited within the organization and from local services. We organized three separate groups who met over 10 weekly in-person, facilitated sessions: millennials (age 19-29) no longer in school, precariously employed adults (age 30-55) and older adults near retirement (age 55-64). We applied principles of adult education and peer-to-peer learning. We administered surveys at intake, at exit and at 3 months after the intervention, and conducted three focus groups. RESULTS Fifty-nine people took part. At 3 months, participants had sustained higher rates of optimism about their financial situation (54% improved from baseline), their degree of control (55% improved) and stress around finances (50% improved). In focus groups, participants reported greater understanding of their finances, that they were not alone in struggling with finances, and that it was useful to meet with others. One group continued to meet for several months after the intervention. CONCLUSIONS In this study, a peer-to-peer intervention helped address a key social determinant of health, likely through reducing stigma, providing group support and creating a space to discuss solutions. Primary care can host these interventions and help engage potential participants.
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Affiliation(s)
- Andrew D Pinto
- The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,University of Toronto Practice-Based Research Network (UTOPIAN), Toronto, ON, Canada
| | - Monica Da Ponte
- Strive, Toronto, ON, Canada.,Shift & Build, Toronto, ON, Canada
| | - Madeleine Bondy
- The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Undergraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Amy Craig-Neil
- The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Suhal Ahmed
- Shelter, Support, and Housing Administration, City of Toronto, ON, Canada
| | | | - Alyssa Swartz
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Samantha Green
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Beardon S, Woodhead C, Cooper S, Raine R, Genn H. Health-justice partnerships: innovation in service delivery to support mental health. JOURNAL OF PUBLIC MENTAL HEALTH 2020. [DOI: 10.1108/jpmh-03-2020-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to introduce the concept of “health-justice partnership” (HJP), the provision of legal assistance for social welfare issues in health-care settings. It discusses the role of these partnerships in supporting health and care for people with mental health issues.
Design/methodology/approach
The authors describe an example of an HJP; discuss the rationale and evidence for this approach in relation to mental health; and reflect on implementation challenges and future directions in the UK. The authors draw on both health and legal literature to frame the discussion.
Findings
Social welfare legal needs have negative impacts on mental well-being and are more likely to occur among people with mental health conditions. Integrating legal assistance with healthcare services can improve access to support for those with unmet need. High-quality research has demonstrated positive impacts for mental health and well-being as a result of HJP interventions. Both further research and wider strategies are required to support implementation of HJPs in practice.
Originality/value
Legal assistance is rarely positioned as a health intervention, yet it is an effective tool to address social welfare issues that are harmful to mental health and to which people experiencing mental health are at greater risk. This paper highlights the importance of the HJP movement as an approach for supporting people with mental health issues.
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Lu L, Gavin A, Drummond FJ, Sharp L. Cumulative financial stress as a potential risk factor for cancer-related fatigue among prostate cancer survivors. J Cancer Surviv 2020; 15:1-13. [PMID: 32740694 PMCID: PMC7822770 DOI: 10.1007/s11764-020-00906-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/14/2020] [Indexed: 01/03/2023]
Abstract
Introduction Cancer-related fatigue (CRF) is the most commonly reported treatment-related side effect of prostate cancer (PCa). Recognition of financial hardship among cancer survivors is growing. We investigated, for the first time, associations between levels of financial stress and CRF among PCa survivors. Methods We used data from PCa survivors who had been identified through two population-based cancer registries covering the Republic of Ireland and Northern Ireland and had completed a postal questionnaire. CRF was measured by the fatigue subscale of the EORTC QLQ-C30. Financial stress was assessed as household ability to make ends meet (i) pre-diagnosis and (ii) at questionnaire completion (post-diagnosis). Multivariable logistic regression was used to relate financial stress to clinically important CRF (fatigue subscale score ≥ 39 of a possible 100). Results Two thousand four hundred fifty-eight PCa survivors were included. Of these, 268 (10.9%) reported pre-diagnosis financial stress only, 317 (12.9%) post-diagnosis stress only and 270 (11.0%) both pre- and post-diagnosis stress (cumulative stress); 470 (19.1%) reported clinically important CRF. After controlling for confounders, survivors with cumulative financial stress exposure were significantly more likely to have CRF (OR = 4.58, 95% CI 3.30–6.35, p < 0.001), compared with those without financial stress. There was a suggestion of a dose-response relationship (OR = 1.83, 95% CI 1.27–2.65, p = 0.001 for pre-diagnosis financial stress only; and OR = 4.11, 95% CI 3.01–5.61, p < 0.001 for post-diagnosis financial stress only). Conclusions Financial stress may be an independent risk factor for CRF. Implications for Cancer Survivors There may be benefits in targeting interventions for reducing CRF towards survivors with financial stress, or developing strategies to reduce financial stress. Electronic supplementary material The online version of this article (10.1007/s11764-020-00906-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liya Lu
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle, England.
| | - Anna Gavin
- Northern Ireland Cancer Registry, Queen's College Belfast, Belfast, Northern Ireland
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle, England
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Lueckmann SL, Schumann N, Hoffmann L, Roick J, Kowalski C, Dragano N, Richter M. 'It was a big monetary cut'-A qualitative study on financial toxicity analysing patients' experiences with cancer costs in Germany. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:771-780. [PMID: 31802578 DOI: 10.1111/hsc.12907] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/28/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
Receiving information about expected costs promptly after a cancer diagnosis through psycho-oncology care or social counselling is crucial for patients to be prepared for the financial impact. Nevertheless, less is known about financial impacts for cancer patients in countries with statutory health insurance. This study aims to explore the full scope of costs that constitute the financial impact of a cancer diagnosis in Germany and to identify the reasons for high financial decline. Semistructured interviews with 39 cancer patients were conducted between May 2017 and April 2018. Narratives were analysed via qualitative content analysis. Several factors influenced cancer patients' indirect costs and direct medical and non-medical costs. For many patients, these changes resulted in higher indirect costs caused by income losses, especially when surcharges for shift work, travel expenses or company benefits ceased and were not reimbursed. Higher direct medical costs were caused by co-payments and additional non-refundable costs. Non-medical costs were reported to increase for some patients and to decrease for others, as for example, leisure activity costs either increasing because of pampering oneself to cope with the diagnosis and undergoing therapy or decreasing because of not being able to participate in leisure activities during therapy. When analysing the financial impacts of individuals' total costs, we found that some patients experienced no financial decline or an overall financial increase. Most patients experienced overall higher costs, and income loss was the main driver of a high financial decline. Nevertheless, decreased non-medical costs due to lower work-related and leisure activity costs could compensate for these higher costs. Cancer patients are confronted with a variety of changes in their financial situations, even in countries with statutory health insurance. Screening for cancer patients with a high risk of financial decline should consider any effects on indirect costs and direct medical and nonmedical costs.
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Affiliation(s)
- Sara Lena Lueckmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Nadine Schumann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Laura Hoffmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Julia Roick
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | | | - Nico Dragano
- Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
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Schröder SL, Schumann N, Fink A, Richter M. Coping mechanisms for financial toxicity: a qualitative study of cancer patients’ experiences in Germany. Support Care Cancer 2019; 28:1131-1139. [DOI: 10.1007/s00520-019-04915-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
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Knowledge and attitudes to prescription charges in New Zealand and England. Res Social Adm Pharm 2018; 14:180-186. [DOI: 10.1016/j.sapharm.2017.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/05/2017] [Accepted: 02/20/2017] [Indexed: 11/21/2022]
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Gupta A, Dhillon PK, Govil J, Bumb D, Dey S, Krishnan S. Multiple Stakeholder Perspectives on Cancer Stigma in North India. Asian Pac J Cancer Prev 2016; 16:6141-7. [PMID: 26320509 DOI: 10.7314/apjcp.2015.16.14.6141] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer is a leading cause of death worldwide. A large proportion of cancer deaths are preventable through early detection but there are a range of social, emotional, cultural and financial dimensions that hinder the effectiveness of cancer prevention and treatment efforts. Cancer stigma is one such barrier and is increasingly recognized as an important factor influencing health awareness and promotion, and hence, disease prevention and control. The impact and extent of stigma on the cancer early detection and care continuum is poorly understood in India. OBJECTIVES To evaluate cancer awareness and stigma from multiple stakeholder perspectives in North India, including men and women from the general population, health care professionals and educators, and cancer survivors. MATERIALS AND METHODS A qualitative study was conducted with in-depth interviews (IDIs) and focus group discussions (FGDs) among 39 individuals over a period of 3 months in 2014. Three groups of participants were chosen purposively - 1) men and women who attended cancer screening camps held by the Indian Cancer Society, Delhi; 2) health care providers and 3) cancer survivors. RESULTS Most participants were unaware of what cancers are in general, their causes and ways of prevention. Attitudes of families towards cancer patients were observed to be positive and caring. Nevertheless, stigma and its impact emerged as a cross cutting theme across all groups. Cost of treatment, lack of awarenes and beliefs in alternate medicines were identified as some of the major barriers to seeking care. CONCLUSIONS This study suggests a need for spreading awareness, knowledge about cancers and assessing associated impact among the people. Also Future research is recommended to help eradicate stigma from the society and reduce cancer-related stigma in the Indian context.
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Affiliation(s)
- Adyya Gupta
- South Asia Network for Chronic Disease (SANCD), Public Health Foundation of India, New Delhi, India E-mail :
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Abstract
It is now a full decade since Paylor and Orgel (2004) called for social work to 'wake up' to hepatitis C (HCV). In that time, a small but significant body of social research has developed which has highlighted the far-reaching social consequences of living with HCV. Using this as a foundation, Paylor and Mack (2010) expanded arguments on the role of social work and identified specific areas where social work might become involved, arguing that the profession is uniquely placed and skilled, to respond and provide support. This article draws on qualitative in-depth interviews with twenty-one people who (had) lived with HCV in the UK, to strengthen and broaden the argument that social work and social care need to urgently take a bigger role in working with people with HCV, given the cross-cutting and wide range of issues that arise. This is the first study which uses participant data to argue for the need for social work involvement and in that it highlights a number of points in the experience where social work support is needed including pre and post diagnosis, whilst on treatment and after treatment.
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Affiliation(s)
| | - Ian Paylor
- *Correspondence to Dr Ian Paylor, Department of Sociology, Bowland College North, Lancaster University, Lancaster, LA1 4YD, UK. E-mail:
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Allmark P, Baxter S, Goyder E, Guillaume L, Crofton-Martin G. Assessing the health benefits of advice services: using research evidence and logic model methods to explore complex pathways. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:59-68. [PMID: 23039788 PMCID: PMC3557712 DOI: 10.1111/j.1365-2524.2012.01087.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/27/2012] [Indexed: 06/01/2023]
Abstract
Poverty is positively associated with poor health; thus, some healthcare commissioners in the UK have pioneered the introduction of advice services in health service locations. Previous systematic reviews have found little direct evidence for a causal relationship between the provision of advice and physical health and limited evidence for mental health improvement. This paper reports a study using a broader range of types of research evidence to construct a conceptual (logic) model of the wider evidence underpinning potential (rather than only proven) causal pathways between the provision of advice services and improvements in health. Data and discussion from 87 documents were used to construct a model describing interventions, primary outcomes, secondary and tertiary outcomes following advice interventions. The model portrays complex causal pathways between the intervention and various health outcomes; it also indicates the level of evidence for each pathway. It can be used to inform the development of research designed to evaluate the pathways between interventions and health outcomes, which will determine the impact on health outcomes and may explain inconsistencies in previous research findings. It may also be useful to commissioners and practitioners in making decisions regarding development and commissioning of advice services.
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Affiliation(s)
- Peter Allmark
- Health and Social Care Research Centre, Sheffield Hallam University, UK.
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Céilleachair AÓ, Costello L, Finn C, Timmons A, Fitzpatrick P, Kapur K, Staines A, Sharp L. Inter-relationships between the economic and emotional consequences of colorectal cancer for patients and their families: a qualitative study. BMC Gastroenterol 2012; 12:62. [PMID: 22676509 PMCID: PMC3406941 DOI: 10.1186/1471-230x-12-62] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 06/07/2012] [Indexed: 11/28/2022] Open
Abstract
Background While the evidence-base concerning the economic impact of cancer for patients and their families/carers has grown in recent years, there is little known about how emotional responses to cancer influence this economic impact. We investigated the economic costs of cancer in the context of patients’ emotions and how these both shaped the patient and family burden. Methods Health professionals from six hospitals invited patients diagnosed with colorectal cancer (ICD10 C18-C20) within the previous year to take part in the study. Semi-structured face-to-face interviews were conducted with patients and, where available, a family member. Interviews covered medical and non-medical costs incurred as a result of cancer and the impact of these on the lives of the patient and their family. Interviews were audio-recorded. Recordings were transcribed verbatim and these data were analysed qualitatively using thematic content analysis. Results Twenty-two patients with colorectal cancer (17 colon and 5 rectal; 14 women and 8 men) were interviewed; 6 were accompanied by a family member. Important cancer-related financial outlays included: travel and parking associated with hospital appointments; costs of procedures; increased household bills; and new clothing. Cancer impacted on employed individuals’ ability to work and depressed their income. The opportunity cost of informal care for carers/family members, especially immediately post-diagnosis, was a strong theme. All patients spoke of the emotional burden of colorectal cancer and described how this burden could lead to further costs for themselves and their families by limiting work and hindering their ability to efficiently manage their expenses. Some patients also spoke of how economic and emotional burdens could interact with each other. Support from employers, family/carers and the state/health services and patients’ own attitudes influenced this inter-relationship. Conclusions The economic impact of colorectal cancer on patients and their families is complex. This study suggests that the economic costs and the emotional impact of cancer are often related and can exacerbate each other, but that various factors can meditate this inter-relationship.
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Rogers SN, Harvey-Woodworth CN, Lowe D. Patients' perspective of financial benefits following head and neck cancer in Merseyside and Cheshire. Br J Oral Maxillofac Surg 2011; 50:404-9. [PMID: 21993178 DOI: 10.1016/j.bjoms.2011.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 07/22/2011] [Indexed: 11/25/2022]
Abstract
The aim of this interview study was to ask patients with head and neck cancer in the Mersey region about their need for financial benefits, the advice they were given about benefits and financial matters, and the financial burden of the disease. Stratified quota sampling was by employment status, whether work had been affected by the cancer, and by sex. Of 51 interviewees (mean (SD) age 61(8) years) 20 were retired, 11 were unemployed, 13 worked full-time, and 7 worked part-time. Cancer had affected the work status of 24. Since diagnosis 57% had suffered financially; this was particularly high in those who had retired (65%), and in those whose work had been affected by cancer (79%). Quality of life had decreased in 53% as a result of the financial impact of the disease. This was most common in the unemployed (64%), and in those whose work was affected by cancer (83%). Only a quarter had been given adequate help and information about finance; this was lowest in the unemployed (18%) and highest in those who were fully employed (39%). One third (17/51) had never claimed benefits. The most common benefits were Disability Living Allowance and Incapacity Benefit. Two-thirds (21/31) had applied for benefits after diagnosis, 18 of these were directly as a result of the disease. The median (IQR) weekly income from benefits was £88 (£60-170). Patients and carers need better access to financial advice. We suggest that each multidisciplinary team should have a designated benefits or financial advisor who is readily available to patients in the clinic and on the ward.
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Affiliation(s)
- S N Rogers
- Evidence-Based Practice Research Centre, Faculty of Health, Edge Hill University, St Helens Road, Ormskirk L39 4QP, UK.
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