scholarly journals '…If I don't have that sort of money again, what happens?': adapting a qualitative model to conceptualise the consequences of out-of-pocket expenses for cancer patients in mixed health systems

2020 ◽  
Vol 44 (3) ◽  
pp. 355
Author(s):  
Jade C. Newton ◽  
Harry Hohnen ◽  
Claire E. Johnson ◽  
Angela Ives ◽  
Sandy McKiernan ◽  
...  
Keyword(s):  
Health System ◽  
Cancer Treatment ◽  
Coping Strategies ◽  
Cancer Patients ◽  
Healthcare System ◽  
Economic Consequences ◽  
Health Providers ◽  
Health Practitioners ◽  
Out Of Pocket Expenses ◽  
Western Australian

ObjectiveThe aim of this study was to explore Western Australian cancer patients’ experiences of out-of-pocket expenses (OOPE) during diagnosis and cancer treatment using a phenomenological approach. MethodsSemi-structured interviews were conducted with a purposive convenience sample of 40 Western Australian cancer patients diagnosed with breast, lung, prostate or colorectal cancer. Participants were asked about the impact of their diagnosis, the associated costs and their experience within the health system. Data were analysed using thematic content analysis. ResultsThree key themes influencing participant OOPE experiences were identified: (1) personal circumstances; (2) communication with health providers; and (3) coping strategies. Despite Australia’s public healthcare system, several participants found the costs affected their financial security and resorted to coping strategies including medication rationing and restrictive household budgeting. The key themes had a complex and interrelated effect on patient OOPE experiences and were used to adapt Carrera et al.’s model of economic consequences of cancer treatment on the patient and patient coping to describe these relationships in a mixed healthcare system. ConclusionOrganised efforts must be implemented to mitigate maladaptive coping strategies being used by cancer patients: (1) health providers should seek informed financial consent from patients before commencing treatment; and (2) financial aid and support schemes for cancer patients should be reviewed to ensure they are delivered equitably. What is known on this topic?The financial cost of cancer can have significant adverse effects on cancer patients. Although financial transparency is desired by cancer patients, its implementation in practice is not clear. What does this paper add?This study adapts a conceptual model for the economic consequences of a cancer diagnosis and repurposes it for a mixed public–private health system, providing a framework for understanding downstream consequences of cancer costs and highlighting opportunities for intervention. What are the implications for health practitioners?Health practitioners need to initiate discussions concerning treatment costs earlier with cancer patients. There are several resources and guides available to assist and facilitate financial transparency. Without urgent attention to the financial consequences of cancer treatment and related expenses, we continue to leave patients at risk of resorting to maladaptive coping strategies, such as medication rationing and restrictive household budgeting.

Access to a quality healthcare among prisoners – perspectives of health providers of a prison infirmary, Ghana

2019 ◽  
Vol 15 (4) ◽  
pp. 349-365
Author(s):  
Terrylyna Baffoe-Bonnie ◽  
Samuel Kojo Ntow ◽  
Kwasi Awuah-Werekoh ◽  
Augustine Adomah-Afari
Keyword(s):  
Health System ◽  
Healthcare System ◽  
Theoretical Perspective ◽  
Integrated Approach ◽  
Structured Interview ◽  
Health Providers ◽  
Policy Makers ◽  
Content Type ◽  
Quality Healthcare ◽  
System Factors

Purpose The purpose of this paper is to explore the influence of health system factors on access to a quality healthcare among prisoners in Ghana. Design/methodology/approach Data were gathered using different qualitative methods (interviews and participant observation) with staff of the James Camp Prison, Accra. Findings were analyzed using a framework method for the thematic analysis of the semi-structured interview data; and interpreted with the theoretical perspective of health systems thinking and innovation. Findings The study concludes that health system factors such as inadequate funding for health services, lack of skilled personnel and a paucity of essential medical supplies and drugs negatively affected the quality of healthcare provided to inmates. Research limitations/implications The limited facilities available and the sample size (healthcare workers and prison administrators) impeded the achievement of varied views on the topic. Practical implications The paper recommends the need for health policy makers and authorities of the Ghana Prison Service to collaborate and coordinate in a unified way to undertake policy analysis in an effort to reform the prisons healthcare system. Social implications The national health insurance scheme was found to be the financing option for prisoners’ access to free healthcare with supplementation from the Ghana Prison Service. The study recommends that policy makers and healthcare stakeholders should understand and appreciate the reality that the provision of a quality healthcare for prisoners is part of the entire system of healthcare service delivery in Ghana and as such should be given the needed attention. Originality/value This is one of few studies conducted on male only prisoners/prison in the context of Ghana. It recommends the need for an integrated approach to ensure that the entire healthcare system achieves set objectives in response to the primary healthcare concept.

scholarly journals Tackling Health System Delays for Cancer Patients in LMICs: An Innovative Multicomponent Programmatic Intervention in Botswana

2016 ◽  
Vol 2 (3_suppl) ◽  
pp. 41s-42s ◽  
Author(s):  
Neo M. Tapela ◽  
Malebogo Pusoentsi ◽  
Kerapetse Botebele ◽  
Michael Peluso ◽  
Isaac Nkele ◽  
...  
Keyword(s):  
Health System ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Median Time ◽  
Conflicts Of Interest ◽  
Local Health ◽  
Care Coordinator ◽  
Bayer Healthcare ◽  
The Impact

Abstract 67 Background: Health system delays are a major contributor to poor outcomes among cancer patients in low- and middle-income countries (LMICs). In Botswana, while median time from cancer-related symptom onset to first presentation at local health facility is 29 days, median time to initiation of cancer treatment is 401 days. Challenges to timely diagnosis and care include clinicians' lack of knowledge, limited diagnostic capacity, poor coordination between facilities, and socioeconomic barriers of patients that impede follow-up. We sought to develop an intervention to improve access to prompt cancer care. Methods: Participating facilities are all public health facilities (21 health posts, 14 clinics, 2 hospitals) in Botswana's Kweneng-East district as well as the national referral hospital. The five components of intervention are a) training of clinicians at primary facilities on evaluation of patients with suspected cancer, b) implementation of a standardized referral algorithm for cancer suspects, c) introduction of care-coordinator role to support patient and clinician navigation of the health system, d) use of SMS-based platform to support follow-up, e) provision of transport support for vulnerable patients. The primary endpoints are stage at cancer diagnosis and time from initial presentation to initiation of cancer treatment. Evaluation of the intervention's impact will include comparing endpoints following intervention with those at baseline and those among patients residing outside the Kweneng-East district. Results: Implementation of the above multi-component intervention will be presented, including a standardized algorithm to guide the evaluation, triage and referral of patients, an intensive one-day didactic training program that adapts curricula employed in the region, and the impact of training on knowledge. Conclusion: In conducting this study, we hope to identify effective program-based measures to reduce delays and improve cancer outcomes in Botswana. These measures may be scaled to other districts, and may be applicable to similar settings in the region. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Neo M. Tapela No relationship to disclose Malebogo Pusoentsi No relationship to disclose Kerapetse Botebele No relationship to disclose Michael Peluso No relationship to disclose Isaac Nkele No relationship to disclose Jason Efstathiou Honoraria: Medivation/Astellas, Bayer Healthcare Pharmaceuticals Consulting or Advisory Role: Medivation/Astellas, Bayer Healthcare Pharmaceuticals Tomer Barak No relationship to disclose Scott Dryden-Peterson No relationship to disclose

Brief Report: Frequency and Perceived Effectiveness of Mental Health Providers’ Coping Strategies during COVID-19 (Preprint)

2020 ◽  
Author(s):  
Shannon Reilly ◽  
Zachary A. Souillard ◽  
William T. McCuddy ◽  
James J. Mahoney III
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Coping Strategies ◽  
Individual Therapy ◽  
Mental Health Practitioners ◽  
Career Stage ◽  
Mental Health Providers ◽  
Health Providers ◽  
Perceived Effectiveness ◽  
Health Practitioners

BACKGROUND There has been an emphasis on understanding detrimental effects of coronavirus disease (COVID-19) on individuals’ mental health, including increased mood symptoms, sleep and appetite disturbance, and substance use. U.S. mental health practitioners have responded by adjusting their practices, particularly related to increasing tele-mental health treatment. Healthcare workers may experience increased emotional and behavioral health concerns to a greater degree even than the general public. Mental health practitioners are not immune to psychological distress and simultaneously have an ethical imperative to maintain their wellbeing. OBJECTIVE The purpose of the present study was to descriptively examine the frequency with which U.S. mental health practitioners use various coping strategies and the perceived effectiveness of these strategies during the COVID-19 pandemic. Further, the study explored how use of coping strategies and their perceived effectiveness differed for mental health providers across career stages (i.e., trainees versus licensed practitioners [LPs]). METHODS Qualtrics survey data were collected from mental health practitioners (N = 888) as part of a larger study surveying responses to the COVID-19 pandemic. Participants were asked about the strategies they were using to manage COVID-19-associated anxiety/distress and how effective they perceived their chosen strategies to be (1 = very ineffective to 5 = very effective). Bonferroni-adjusted chi-square tests and t-tests were conducted to assess differences by career stage. RESULTS Overall, respondents used various coping strategies to manage COVID-19-related anxiety/distress. Behavioral strategies were most common, particularly distraction/engaging in an enjoyable activity (88.63%), spending time with loved ones (77.82%), and exercise (72.64%). Respondents reported engaging other professionals both for work-related matters (e.g., peer consultation, 56.76%) and personal matters (e.g., individual therapy or counseling, 16.10%). Over one-quarter reported using alcohol to cope (28.27%). Overall, respondents generally perceived the strategies they employed to be “somewhat” to “very effective” in managing their COVID-19-related anxiety/distress; no strategies were generally perceived as ineffective. Compared to licensed practitioners, trainees were significantly more likely to manage COVID-19-related anxiety/distress using supervision (p < .001) and substances other than alcohol or tobacco (p = .001). There were no statistically significant differences in how effective trainees and LPs perceived each strategy. CONCLUSIONS Overall, a vast majority of U.S. mental health practitioners – trainees and LPs alike – reported using predominantly behavioral coping strategies, which they perceived to be effective, during the first months of the COVID-19 pandemic. During and after the pandemic, it will be important for mental health providers to continue to practice effective coping strategies and other forms of self-care in order to provide optimal services to their clients. The present study offers specific ways in which institutions and employers may help mental health practitioners during this stressful time, such as checking in on their wellbeing and offering substance use education, particularly to trainees.

scholarly journals Active Participation, Mind–Body Stabilization, and Coping Strategies with Integrative Medicine in Breast Cancer Patients

2021 ◽  
Vol 20 ◽  
pp. 153473542199010
Author(s):  
Anna-Katharin Theuser ◽  
Sophia Antoniadis ◽  
Hanna Langemann ◽  
Sonja Wasner ◽  
Katharina Grasruck ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Coping Strategies ◽  
Cancer Patients ◽  
Integrative Medicine ◽  
Active Participation ◽  
Treatment Goals ◽  
Breast Cancer Patients ◽  
Patient Reported ◽  
And Coping

Purpose: Increasing numbers of breast cancer survivors have led to a growing demand for integrative medicine. When patients have completed treatments associated with severe side effects, attention turns to reducing psychological symptoms, coping behavior, and self-care. The aim of this study was to assess patient-reported benefits in relation to active participation, mind–body stabilization, and coping strategies in breast cancer patients receiving integrative medicine. Methods: In a cross-sectional study, health counseling and treatment provided by a standardized integrative medicine consultancy service at the University Breast Center of Franconia were evaluated in 75 breast cancer patients over a 15-month period. At the baseline, the patients answered a questionnaire on their medical history, symptoms, and the treatment goals they were hoping to achieve with integrative medicine. Patient-reported outcomes relative to active participation, mind–body stabilization, and coping strategies were analyzed. Results: A large majority of the patients had previous experience with integrative medicine (91%). Most reported that they achieved their treatment goals with integrative medicine. Ninety-one percent achieved active participation in cancer treatment, 90% mind–body stabilization, and 79% improvement in coping strategies. Besides active participation, which was greatest in patients with stable disease, the success of integrative therapy was independent of age, concomitant diseases, previous integrative medicine experience, treatment state, and systemic cancer therapy. Conclusion: Breast cancer patients benefit from the counseling and treatment provided with integrative medicine in mind–body stabilization and coping with cancer. Active participation in cancer treatment is important for the patients. Integrative treatment services should form part of routine patient care.

A cross-sectional analysis of out-of-pocket expenses for people living with a cancer in rural and outer metropolitan Western Australia

2021 ◽  
Vol 45 (2) ◽  
pp. 148
Author(s):  
Neli S. Slavova-Azmanova ◽  
Jade C. Newton ◽  
Claire E. Johnson ◽  
Harry Hohnen ◽  
Angela Ives ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cancer Patients ◽  
Western Australia ◽  
Private Health Insurance ◽  
Cost Transparency ◽  
Cancer Centre ◽  
Rural Study ◽  
Out Of Pocket Expenses ◽  
Study Participants ◽  
Western Australian

ObjectiveTo determine the extent of medical and non-medical out-of-pocket expenses (OOPE) among regional/rural and outer metropolitan Western Australian patients diagnosed with cancer, and the factors associated with higher costs. MethodsCross-sectional data were collected from adult patients living in four regional/rural areas and two outer metropolitan regions in Western Australia who had been diagnosed with breast, prostate, colorectal or lung cancer. Consenting participants were mailed demographic and financial questionnaires, and requested to report all OOPE related to their cancer treatment. ResultsThe median total OOPE reported by 308 regional/rural participants and 119 outer metropolitan participants were A$1518 (interquartile range (IQR): A$581–A$3769) and A$2855 (IQR: A$958–A$7142) respectively. Participants most likely to experience higher total OOPE were younger than 65 years of age, male, resided in the outer metropolitan area, worked prior to diagnosis, had private health insurance, were in a relationship, and underwent surgery. Multivariate analysis of regional/rural participants revealed that receiving care at a rural cancer centre was associated with significantly lower non-medical OOPE (estimated mean A$805, 95% confidence interval (CI): A$735–A$875, P=0.038; compared with other rural participants (A$1347, 95% CI: A$743–A$1951, P&lt;0.001)). ConclusionThe cancer patients who participated in this study experienced variation in OOPE, with outer metropolitan participants reporting higher OOPE compared with their regional/rural counterparts. There is a need for cost transparency and access to care close to home, so that patients can make informed choices about where to receive their care. What is known about the topic?In recent years, OOPE for health care in general and cancer in particular have been widely debated by consumers and not-for-profit organisations; the topic has attracted much political attention because it affects both equity and access to care and has wider financial implications for the community. Research studies and reports from both consumer organisations and a Ministerial Advisory Committee found that cancer patients can face exorbitant out-of-pocket costs, and that individuals with private health insurance and those with prostate and breast cancer reported higher costs. In Western Australia, a cancer centre providing comprehensive cancer care was established in the second most populous region to ameliorate the high costs for travel and accommodation that regional cancer patients are known to experience. What does this paper add?This study is unique because it collected detailed cost information from patients and reports on the OOPE of regional/rural and outer metropolitan Western Australian patients receiving care for one of the four most common cancers; it therefore offers novel insight into the experiences of these groups. This study demonstrates that outer metropolitan cancer patients are experiencing much higher OOPE compared with regional/rural cancer patients. Additionally, regional/rural study participants who accessed a Regional Cancer Centre experienced significantly lower non-medical OOPE, compared with regional/rural study participants receiving care elsewhere. What are the implications for practitioners?First, there is a need for improved communication of OOPE to minimise costs to the patient, for example, by facilitating access to local cancer care. Health service providers and insurance companies can improve cost transparency for cancer patients by making this information more readily available, allowing patients to make informed financial choices about where to seek care. Second, the needs of working patients deserve specific attention. These patients face significant work uncertainty and additional distress following a cancer diagnosis.

scholarly journals Prolonged SARS-CoV-2-RNA Detection from Nasopharyngeal Swabs in an Oncologic Patient: What Impact on Cancer Treatment?

2021 ◽  
Vol 28 (1) ◽  
pp. 847-852
Author(s):  
Anna Ferrari ◽  
Marco Trevenzoli ◽  
Lolita Sasset ◽  
Elisabetta Di Liso ◽  
Toni Tavian ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Clinical Symptoms ◽  
Palliative Radiotherapy ◽  
Rt Pcr ◽  
Cancer Treatments ◽  
Global Challenge ◽  
Viral Culture ◽  
Pcr Assays

The pandemic of SARS-CoV-2 is a serious global challenge affecting millions of people worldwide. Cancer patients are at risk for infection exposure and serious complications. A prompt diagnosis of SARS-CoV-2 infection is crucial for the timely adoption of isolation measures and the appropriate management of cancer treatments. In lung cancer patients the symptoms of infection 19 may resemble those exhibited by the underlying oncologic condition, possibly leading to diagnostic overlap and delays. Moreover, cancer patients might display a prolonged positivity of nasopharyngeal RT-PCR assays for SARS-CoV-2, causing long interruptions or delay of cancer treatments. However, the association between the positivity of RT-PCR assays and the patient’s infectivity remains uncertain. We describe the case of a patient with non-small cell lung cancer, and a severe ab extrinseco compression of the trachea, whose palliative radiotherapy was delayed because of the prolonged positivity of nasopharyngeal swabs for SARS-CoV-2. The patient did not show clinical symptoms suggestive of active infection, but the persistent positivity of RT-PCR assays imposed the continuation of isolation measures and the delay of radiotherapy for over two months. Finally, the negative result of SARS-CoV-2 viral culture allowed us to verify the absence of viral activity and to rule out the infectivity of the patient, who could finally continue her cancer treatment.

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