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Sensitivity of Psychosocial Distress Screening to Identify Cancer Patients at Risk for Financial Hardship During Care Delivery
- Source :
- JCO Oncol Pract
- Publication Year :
- 2021
- Publisher :
- American Society of Clinical Oncology (ASCO), 2021.
-
Abstract
- PURPOSE: Patients with cancer frequently encounter financial hardship, yet systematic strategies to identify at-risk patients are not established in care delivery. We assessed sensitivity of distress-based screening to identify patients with cancer-related financial hardship and associated care delivery outcomes. METHODS: A survey of 225 patients at a large cancer center assessed cancer-related financial hardship (0-10 Likert scale; highest quintile scores ≥ 5 defined severe hardship). Responses were linked to electronic medical records identifying patients’ distress screening scores 6 months presurvey (0-10 scale) and outcomes of missed cancer care visits and bad debt charges (unrecovered patient charges) within 6 months postsurvey. A positive screen for distress was defined as score ≥ 4. We analyzed screening test characteristics for identifying severe financial hardship within 6 months and associations between financial hardship and outcomes using logistic models. RESULTS: Although patients with positive distress screens were more likely to report financial hardship (odds ratio [OR], 1.21; 1.08-1.37; P < .001), a positive distress screen was only 48% sensitive and 70% specific for identifying severe financial hardship. Patients with worse financial hardship scores were more likely to miss oncology care visits within 6 months (for every additional point in financial hardship score from 0 to 10, OR, 1.28; 1.12-1.47; P < .001). Of patients with severe hardship, 72% missed oncology visits versus 35% without severe hardship ( P = .006). Patients with worse hardship were more likely to incur any bad debt charges within 6 months (OR, 1.32; 1.13-1.54; P < .001). CONCLUSION: Systematic financial hardship screening is needed to help mitigate adverse care delivery outcomes. Existing distress-based screening lacks sensitivity.
- Subjects :
- Finance
Oncology (nursing)
business.industry
Health Policy
MEDLINE
Cancer
Financial Stress
medicine.disease
ORIGINAL CONTRIBUTIONS
03 medical and health sciences
0302 clinical medicine
Oncology
Neoplasms
Surveys and Questionnaires
030220 oncology & carcinogenesis
medicine
Humans
Distress screening
030212 general & internal medicine
business
Delivery of Health Care
human activities
Psychosocial
Early Detection of Cancer
health care economics and organizations
Subjects
Details
- ISSN :
- 26881535 and 26881527
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- JCO Oncology Practice
- Accession number :
- edsair.doi.dedup.....0ef1d65e5f3a04145a533ef0ba0b3b9c