Continuous financial toxicity screening in community oncology.

Abstract

1588 Background: Financial Toxicity (FT) has been repeatedly linked with adverse cancer clinical outcomes. However, screening practices vary widely, especially in community settings where < 50% routinely proactively engage patients to discuss care costs. This quality improvement pilot examined the feasibility and impact of continuous FT screening in a community-based clinical practice. Methods: Using PDSA methodology, an electronic distress screening (EDS) tool was implemented at each visit at two rural oncology practices. Evidence of FT was defined as answering “yes” to the question “Do you have insurance/financial problems or concerns?” The EDS tool would automatically email the financial navigation (FN) team on “yes” response and patients were contacted by FN within 48 hours. Contact was attempted at least 3 additional times if unable to be reached. Four successive monthly PDSA cycles ran from April to July 2024. In addition to demographic trends, success metrics were: % of screened patients with FT; % of FT patients new to the FN team; number and types of resolutions of FT concerns; and satisfaction and feasibility survey of clinical teams and patients. Results: In the 4-month study,1071 patients were screened using the EDS tool: 169 (16%) affirmed FT. Of those with FT concerns, 140 (83%) were new to FN. The FN team provided a primary resolution to 85 patients of 169 (50%) who alerted. Of the remainder, 45 (27%) could not be contacted after multiple attempts and 39 (23%) reported clicking in error. Primary resolutions included: Charity Care Program Referral (36%), Financial Teaching (29%), Billing Changes (11%), Social Work Referral (9%), Medication Assistance (6%), and Marketplace Insurance Obtained (5%). The patients receiving FN services were majority female (75%) and between 35 and 64 yo (57%). The most prevalent cancer types were Blood/Marrow (35%) and Breast (31%). 66% were white, 24% African American, and 14% Hispanic. Payors included 40% commercial insurance, 31% Medicare, 19% Medicaid, and 9% other. Geographically, 62% of patients resided in rural areas, 24% suburban, and 4% urban. Patient satisfaction with FN was high across all categories; 55% agreed or strongly agreed that FN services helped lower stress about bills. Scores were highest for “FN cared about my concerns and needs” (69%); “would recommend it to others in need” (63%); and “information from FN was clear and easy to understand” (61%). The clinic teams survey in participating locations felt the EDS screening tool was feasible in their practice environment (67%) and reported they felt routine FT screening was useful for patients (67%) (n=9). Conclusions: Structured implementation of routine FT screening with an EDS tool in a rural, oncology community practice is feasible with high patient and clinical team satisfaction and may allow for earlier identification of at-risk patients. Future directions include screening questionnaire refinements and expansion to other clinical sites.