Financial Toxicity of Cancer Care: An Analysis of Financial Burden in Three Distinct Health Care Systems

2021 ◽  
pp. OP.20.00890
Author(s):  
Divya A. Parikh ◽  
Meera Ragavan ◽  
Ritika Dutta ◽  
Jeffrey Garnet Edwards ◽  
James Dickerson ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Care Delivery ◽  
Medical Center ◽  
Financial Burden ◽  
Financial Toxicity ◽  
Cross Sectional Survey ◽  
Factors Associated ◽  
Care Systems ◽  
Comprehensive Score

PURPOSE: The financial toxicity of cancer care is a source of significant distress for patients with cancer. The purpose of this study is to understand factors associated with financial toxicity in three distinct care systems. METHODS: We conducted a cross-sectional survey of patients in three care systems, Stanford Cancer Institute (SCI), VA Palo Alto Health Care System (VAPAHCS), and Santa Clara Valley Medical Center (SCVMC), from October 2017 to May 2019. We assessed demographic factors, employment status, and out-of-pocket costs (OOPCs) and administered the validated COmprehensive Score for financial Toxicity tool. We calculated descriptive statistics and conducted linear regression models to analyze factors associated with financial toxicity. RESULTS: Four hundred forty-four of 578 patients (77%) completed the entire COmprehensive Score for financial Toxicity tool and were included in the analysis. Most respondents at SCI were White, with annual household income (AHI) > $50,000 USD and Medicare insurance. At the VAPAHCS, most were White, with AHI ≤ $50,000 USD and insured by the Veterans Administration. At SCVMC, most were Asian and/or Pacific Islander, with AHI ≤ $25,000 USD and Medicaid insurance. Low AHI ( P < .0001), high OOPCs ( P = .003), and employment changes as a result of cancer diagnosis ( P < .0001) were associated with financial toxicity in the pooled analysis. There was variation in factors associated with financial toxicity by site, with employment changes significant at SCI, OOPCs at SCVMC, and no significant factors at the VAPAHCS. CONCLUSION: Low AHI, high OOPCs, and employment changes contribute to financial toxicity; however, there are variations based on site of care. Future studies should tailor financial toxicity interventions within care delivery systems.

scholarly journals Rapid Implementation of Video Visits in Neurology During COVID-19: Mixed Methods Evaluation (Preprint)

2020 ◽  
Author(s):  
Erika A Saliba-Gustafsson ◽  
Rebecca Miller-Kuhlmann ◽  
Samantha M R Kling ◽  
Donn W Garvert ◽  
Cati G Brown-Johnson ◽  
...  
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Care Delivery ◽  
Medical Center ◽  
Health Care Systems ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Traditional Health ◽  
Traditional Health Care ◽  
Care Systems

BACKGROUND Telemedicine has been used for decades. Despite its many advantages, its uptake and rigorous evaluation of feasibility across neurology’s ambulatory subspecialties has been sparse. However, the COVID-19 pandemic prompted health care systems worldwide to reconsider traditional health care delivery. To safeguard health care workers and patients, many health care systems quickly transitioned to telemedicine, including across neurology subspecialties, providing a new opportunity to evaluate this modality of care. OBJECTIVE To evaluate the accelerated implementation of video visits in ambulatory neurology during the COVID-19 pandemic, we used mixed methods to assess adoption, acceptability, appropriateness, and perceptions of potential sustainability. METHODS Video visits were launched rapidly in ambulatory neurology clinics of a large academic medical center. To assess adoption, we analyzed clinician-level scheduling data collected between March 22 and May 16, 2020. We assessed acceptability, appropriateness, and sustainability via a clinician survey (n=48) and semistructured interviews with providers (n=30) completed between March and May 2020. RESULTS Video visits were adopted rapidly; overall, 65 (98%) clinicians integrated video visits into their workflow within the first 6 implementation weeks and 92% of all visits were conducted via video. Video visits were largely considered acceptable by clinicians, although various technological issues impacted their satisfaction. Video visits were reported to be more convenient for patients, families, and caregivers than in-person visits; however, access to technology, the patient’s technological capacity, and language difficulties were considered barriers. Many clinicians expressed optimism about future utilization of video visits in neurology. They believed that video visits promote continuity of care and can be incorporated into their practice long-term, although several insisted that they can never replace the in-person examination. CONCLUSIONS Video visits are an important addition to clinical care in ambulatory neurology and are anticipated to remain a permanent supplement to in-person visits, promoting patient care continuity, and flexibility for patients and clinicians alike.

scholarly journals Financial toxicity in cancer care: origins, impact, and solutions

2021 ◽  
Vol 11 (11) ◽  
pp. 2043-2054 ◽  
Author(s):  
Hannah R Abrams ◽  
Sienna Durbin ◽  
Cher X Huang ◽  
Shawn F Johnson ◽  
Rahul K Nayak ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
Financial Burden ◽  
Indirect Costs ◽  
Future Research ◽  
Financial Toxicity ◽  
Patients With Cancer ◽  
The Past ◽  
Financial Burdens ◽  
The Impact

Abstract Financial toxicity describes the financial burden and distress that can arise for patients, and their family members, as a result of cancer treatment. It includes direct out-of-pocket costs for treatment and indirect costs such as travel, time, and changes to employment that can increase the burden of cancer. While high costs of cancer care have threatened the sustainability of access to care for decades, it is only in the past 10 years that the term “financial toxicity” has been popularized to recognize that the financial burdens of care can be just as important as the physical toxicities traditionally associated with cancer therapy. The past decade has seen a rapid growth in research identifying the prevalence and impact of financial toxicity. Research is now beginning to focus on innovations in screening and care delivery that can mitigate this risk. There is a need to determine the optimal strategy for clinicians and cancer centers to address costs of care in order to minimize financial toxicity, promote access to high value care, and reduce health disparities. We review the evolution of concerns over costs of cancer care, the impact of financial burdens on patients, methods to screen for financial toxicity, proposed solutions, and priorities for future research to identify and address costs that threaten the health and quality of life for many patients with cancer.

Delivering Coordinated Cancer Care by Building Transactive Memory in a Team of Teams

2016 ◽  
Vol 12 (11) ◽  
pp. 992-999 ◽  
Author(s):  
Elizabeth Henry ◽  
Abigail Silva ◽  
Elizabeth Tarlov ◽  
Cheryl Czerlanis ◽  
Margie Bernard ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Oral Treatment ◽  
Transactive Memory ◽  
Health Care Use ◽  
Care Systems ◽  
Potential Strategy ◽  
Patient Care Delivery

Cancer care delivery is highly complex. Treatment involves coordination within oncology health-care teams and across other teams of referring primary and specialty providers (a team of teams). Each team interfaces with patients and caregivers to offer component parts of comprehensive care. Because patients frequently obtain specialty care from divergent health-care systems resulting in cross-system health-care use, oncology teams need mechanisms to coordinate and collaborate within and across health-care systems to optimize clinical outcomes for all cancer patients. Transactive memory is one potential strategy that can help improve comprehensive patient care delivery. Transactive memory is a process by which two or more team professionals develop a shared system for encoding, storing, and retrieving information. Each professional is responsible for retaining only part of the total information. Applying this concept to a team of teams results in system benefits wherein all teams share an understanding of specialized knowledge held by each component team. The patient’s role as the unifying member of the team of teams is central to successful treatment delivery. This clinical case presents a patient who is receiving oral treatment for advanced prostate cancer within two health systems. The case emphasizes the potential for error when multiple teams function without a point team (the team coordinating efforts of all other primary and specialty teams) and when the specialty knowledge of providers and patients is not well integrated into all phases of the care delivery process.

scholarly journals Rapid Implementation of Video Visits in Neurology During COVID-19: Mixed Methods Evaluation

10.2196/24328 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e24328
Author(s):  
Erika A Saliba-Gustafsson ◽  
Rebecca Miller-Kuhlmann ◽  
Samantha M R Kling ◽  
Donn W Garvert ◽  
Cati G Brown-Johnson ◽  
...  
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Care Delivery ◽  
Medical Center ◽  
Health Care Systems ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Traditional Health ◽  
Traditional Health Care ◽  
Care Systems

Background Telemedicine has been used for decades. Despite its many advantages, its uptake and rigorous evaluation of feasibility across neurology’s ambulatory subspecialties has been sparse. However, the COVID-19 pandemic prompted health care systems worldwide to reconsider traditional health care delivery. To safeguard health care workers and patients, many health care systems quickly transitioned to telemedicine, including across neurology subspecialties, providing a new opportunity to evaluate this modality of care. Objective To evaluate the accelerated implementation of video visits in ambulatory neurology during the COVID-19 pandemic, we used mixed methods to assess adoption, acceptability, appropriateness, and perceptions of potential sustainability. Methods Video visits were launched rapidly in ambulatory neurology clinics of a large academic medical center. To assess adoption, we analyzed clinician-level scheduling data collected between March 22 and May 16, 2020. We assessed acceptability, appropriateness, and sustainability via a clinician survey (n=48) and semistructured interviews with providers (n=30) completed between March and May 2020. Results Video visits were adopted rapidly; overall, 65 (98%) clinicians integrated video visits into their workflow within the first 6 implementation weeks and 92% of all visits were conducted via video. Video visits were largely considered acceptable by clinicians, although various technological issues impacted their satisfaction. Video visits were reported to be more convenient for patients, families, and caregivers than in-person visits; however, access to technology, the patient’s technological capacity, and language difficulties were considered barriers. Many clinicians expressed optimism about future utilization of video visits in neurology. They believed that video visits promote continuity of care and can be incorporated into their practice long-term, although several insisted that they can never replace the in-person examination. Conclusions Video visits are an important addition to clinical care in ambulatory neurology and are anticipated to remain a permanent supplement to in-person visits, promoting patient care continuity, and flexibility for patients and clinicians alike.

The Future of Health Care in South Korea and the UK

2006 ◽  
Vol 5 (3) ◽  
pp. 375-385 ◽  
Author(s):  
Bob Matthews ◽  
Yoonsoon Jung
Keyword(s):  
Health Care ◽  
South Korea ◽  
Care Delivery ◽  
Health Care Systems ◽  
Public Provision ◽  
Capitalist System ◽  
Private Provision ◽  
Care Systems ◽  
Health Care Delivery Systems ◽  
The Uk

This paper discusses and compares the origin and development of the health care systems of South Korea and the UK from the end of WW2 and endeavours to compare outcomes. The paper emphasises the importance of war as a stimulus to the development of national health services in both countries and argues that there is convergence between the UK's nationalised NHS and South Korea's US-modelled capitalist system. Overall, we conclude that there is a possibility not only that the financing and nature of the Korean and UK health care delivery systems may show convergence, but it is not impossible that they will ‘change places’ with the UK system dominated by private provision and South Korea's by public provision.

Prevalence and Workplace Drivers of Burnout in Cancer Care Physicians in Ontario, Canada

2021 ◽  
pp. OP.21.00170
Author(s):  
Simron Singh ◽  
Ashley Farrelly ◽  
Catherine Chan ◽  
Brett Nicholls ◽  
Narges Nazeri-Rad ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Gynecologic Oncology ◽  
Maslach Burnout Inventory ◽  
Well Being ◽  
System Level ◽  
Survey Study ◽  
Cross Sectional Survey ◽  
Questionnaire Response ◽  
Mental Health Patient

PURPOSE: Provider well-being has become the fourth pillar of the quadruple aim for providing quality care. Exacerbated by the global COVID-19 pandemic, provider well-being has become a critical issue for health care systems worldwide. We describe the prevalence and key system-level drivers of burnout in oncologists in Ontario, Canada. METHODS: This is a cross-sectional survey study conducted in November-December 2019 of practicing cancer care physicians (surgical, medical, radiation, gynecologic oncology, and hematology) in Ontario, Canada. Ontario is Canada's largest province (with a population of 14.5 million), and has a single-payer publicly funded cancer system. The primary outcome was burnout experience assessed through the Maslach Burnout Inventory. RESULTS: A total of 418 physicians completed the questionnaire (response rate was 44% among confirmed oncologists). Seventy-three percent (n = 264 of 362) of oncologists had symptoms of burnout (high emotional exhaustion and/or depersonalization scores). Significant drivers of burnout identified in multivariable regression modeling included working in a hectic or chaotic atmosphere (odds ratio [OR] = 15.5; 95% CI, 3.4 to 71.5; P < .001), feeling unappreciated on the job (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), reporting poor or marginal control over workload (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), and not being comfortable talking to peers about workplace stress (OR = 3.0; 95% CI, 1.1 to 7.9; P < .001). Older age (≥ 56 years) was associated with lower odds of burnout (OR = 0.16; 95% CI, 0.1 to 0.4; P < .001). CONCLUSION: Nearly three quarters of participants met predefined standardized criteria for burnout. This number is striking, given the known impact of burnout on provider mental health, patient safety, and quality of care, and suggests Oncologists in Ontario may be a vulnerable group that warrants attention. Health care changes being driven by the COVID-19 pandemic provide an opportunity to rebuild new systems that address drivers of burnout. Creating richer peer-to-peer and leadership engagement opportunities among early- to mid-career individuals may be a worthwhile organizational strategy.

scholarly journals A COMPARATIVE STUDY OF THE PERCEPTIONS OF RURAL DWELLERS TOWARDS HEALTH CARE DELIVERY

2021 ◽  
Vol 9 (04) ◽  
pp. 451-454
Author(s):  
Felix a ◽  
◽  
J. Ugwu ◽  
Clara Okenyi ◽  
◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Significant Relationship ◽  
Survey Design ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Test Analysis ◽  
Rural Dwellers

The present study aimed to comparatively analyze healthcare delivery perception among rural dwellers based on education (formal/informal) and gender. The study adopted a cross-sectional survey design. A total of two hundred rural dwellers comprising males and females participated in the study. Perception towards health care delivery was measured with a self-developed instrument with demographic information. An independent t-test analysis found no statistically significant relationship between education and perception towards health care delivery. However, the result revealed a significant relationship between gender and perception towards health care delivery. Females were found to show a more positive attitude towards health care delivery than their male counterparts. The findings and conclusions are discussed.

scholarly journals A Cross-Sectional Survey Exploring the Impact of the COVID-19 Pandemic on the Cancer Care of Adolescents and Young Adults

2021 ◽  
Vol 28 (4) ◽  
pp. 3201-3213
Author(s):  
Kaitlyn Howden ◽  
Camille Glidden ◽  
Razvan G. Romanescu ◽  
Andrew Hatala ◽  
Ian Scott ◽  
...  
Keyword(s):  
Young Adults ◽  
Cancer Treatment ◽  
Cancer Care ◽  
Negative Impact ◽  
Positive Impact ◽  
Care Delivery ◽  
Adolescents And Young Adults ◽  
P Value ◽  
Cross Sectional Survey ◽  
The Impact

We aimed to describe the negative and positive impacts of changes in cancer care delivery due to COVID-19 pandemic for adolescents and young adults (AYAs) in Canada, as well as the correlates of negative impact and their perspectives on optimization of cancer care. We conducted an online, self-administered survey of AYAs with cancer living in Canada between January and February 2021. Multiple logistic regression was used to identify factors associated with a negative impact on cancer care. Of the 805 participants, 173 (21.5%) experienced a negative impact on their cancer care including delays in diagnostic tests (11.9%), cancer treatment (11.4%), and appointments (11.1%). A prior diagnosis of mental or chronic physical health condition, an annual income of <20,000 CAD, ongoing cancer treatment, and province of residence were independently associated with a negative cancer care impact (p-value < 0.05). The majority (n = 767, 95.2%) stated a positive impact of the changes to cancer care delivery, including the implementation of virtual healthcare visits (n = 601, 74.6%). Pandemic-related changes in cancer care delivery have unfavorably and favorably influenced AYAs with cancer. Interventions to support AYAs who are more vulnerable to the adverse effects of the pandemic, and the thoughtful integration of virtual care into cancer care delivery models is essential.

scholarly journals Cultural Awareness and Sensitivity of Students in a Physical Therapy Program – A Pilot Survey

2018 ◽  
Author(s):  
Olaide Oluwole-Sangoseni ◽  
Michelle Jenkins-Unterberg
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Cultural Sensitivity ◽  
Health Care Professionals ◽  
Cultural Awareness ◽  
Health Care Disparities ◽  
Care Delivery ◽  
The United States ◽  
Cross Sectional Survey ◽  
Significant Difference

Background: Attempts to address health and health care disparities in the United States have led to a renewed focus on the training of healthcare professionals including physical therapists. Current health care policies emphasize culturally competent care as a means of promoting equity in care delivery by health care professionals. Experts agree that cultural insensitivity has a negative association with health professionals’ ability to provide quality care. Objective: To evaluate the cultural awareness and sensitivity of physical therapy (PT) students in a didactic curriculum aimed to increase cultural awareness. Methods: Using the Multicultural Sensitivity Scale (MSS), a cross-sectional survey was conducted to assess cultural sensitivity among three groups of students, (N = 139) from a doctor of physical therapy (DPT) program at a liberal arts university in Saint Louis, MO. Results: Response rate was 76.3%. Participants (n=100) were students in first (DPT1, n=36), third (DPT3, n=36), and sixth (DPT6, n=28) year of the program. Mean ranked MSS score was DPT1 = 45.53, DPT3 = 46.60 DPT6 = 61.91. Kruskal-Wallis analysis of the mean ranked scores showed a significant difference among three groups, H = 6.05 (2, N=100), p ≤ .05. Discussion: Students who have completed the cultural awareness curriculum, and undergone clinical experiences rated themselves higher on the cultural sensitivity/awareness. Results provide initial evidence that experiential learning opportunities may help PT students to more effectively integrate knowledge from classroom activities designed to facilitate cultural competence.

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