Assessing the rate of identification of financial hardship action items and completion of referrals for care (492)

Abstract

Objectives: Financial navigation services describe processes to screen patients for financial hardship (FH) and link patients to financial assistance and resources at the health system level. However, rates of referral and the best workflow to utilize these tools are unknown. We aimed to evaluate the use of FH screening instruments to guide referrals to financial navigation services (i.e., social worker, financial counselor, psycho-oncology counseling) within a health system. Methods: We conducted a pilot study implementing universal FH screening in academic gynecologic oncology practice. A lay navigator conducted FH screening at the start of treatment using the 11-item COmprehensive Score for financial Toxicity (COST <26), moderate/ severe distress on the National Comprehensive Cancer Network Distress Thermometer (score >4), and a 10-item financial needs (FN) checklist asking whether they had difficulty affording certain items (i.e., medications, paying bills, lodging). We abstracted referral placement and follow-up information addressing financial needs from the medical record. Results: We screened 131 patients. The average age was 60.4 years (range: 19-84), and 30.6% were non-White. Cancer types included ovarian (40.0%), uterine (36.6%), cervical (17.6%), and vulvar/vaginal/ other (7.6%). Most patients had a primary disease (55.7%) and were on first-line (55.0%) systemic therapy. Of 12 (9.2%) patients with both FH and moderate/severe distress, three (25%) patients received a referral. Of 13 (9.9%) patients with FH but no/mild distress, three (23.1%) patients received a referral. Of 27 (20.6%) patients with moderate/ severe distress but no FH, five (18.5%) patients received a referral. Of the 70 patients who screened negative for FH or moderate/severe distress, nine patients (12.9%) had referrals; of them, four responded ‘yes’ on the distress thermometer regarding practical concerns, such as financial/cost issues. Of 36 (27.5%) patients who reported > 1 concern on the FN checklist, 11 (30.6%) received a referral, and a majority (n=31, 86%) had either positive FH or distress screens. Conclusions: Despite the implementation of FH and distress screening, only about one in four patients who screened positive for FH, moderate/severe distress, or both, received referrals within the health system to address these positive screens. Some patients who screened negative for FH or moderate/severe distress still received referrals, suggesting that interaction with lay navigators may improve patient access to financial and supportive care resources beyond what an automated process can detect. The financial needs checklist generated the highest percentage of referrals (27.5%) compared to COST and/or distress thermometer screening. Objectives: Financial navigation services describe processes to screen patients for financial hardship (FH) and link patients to financial assistance and resources at the health system level. However, rates of referral and the best workflow to utilize these tools are unknown. We aimed to evaluate the use of FH screening instruments to guide referrals to financial navigation services (i.e., social worker, financial counselor, psycho-oncology counseling) within a health system. Methods: We conducted a pilot study implementing universal FH screening in academic gynecologic oncology practice. A lay navigator conducted FH screening at the start of treatment using the 11-item COmprehensive Score for financial Toxicity (COST <26), moderate/ severe distress on the National Comprehensive Cancer Network Distress Thermometer (score >4), and a 10-item financial needs (FN) checklist asking whether they had difficulty affording certain items (i.e., medications, paying bills, lodging). We abstracted referral placement and follow-up information addressing financial needs from the medical record. Results: We screened 131 patients. The average age was 60.4 years (range: 19-84), and 30.6% were non-White. Cancer types included ovarian (40.0%), uterine (36.6%), cervical (17.6%), and vulvar/vaginal/ other (7.6%). Most patients had a primary disease (55.7%) and were on first-line (55.0%) systemic therapy. Of 12 (9.2%) patients with both FH and moderate/severe distress, three (25%) patients received a referral. Of 13 (9.9%) patients with FH but no/mild distress, three (23.1%) patients received a referral. Of 27 (20.6%) patients with moderate/ severe distress but no FH, five (18.5%) patients received a referral. Of the 70 patients who screened negative for FH or moderate/severe distress, nine patients (12.9%) had referrals; of them, four responded ‘yes’ on the distress thermometer regarding practical concerns, such as financial/cost issues. Of 36 (27.5%) patients who reported > 1 concern on the FN checklist, 11 (30.6%) received a referral, and a majority (n=31, 86%) had either positive FH or distress screens. Conclusions: Despite the implementation of FH and distress screening, only about one in four patients who screened positive for FH, moderate/severe distress, or both, received referrals within the health system to address these positive screens. Some patients who screened negative for FH or moderate/severe distress still received referrals, suggesting that interaction with lay navigators may improve patient access to financial and supportive care resources beyond what an automated process can detect. The financial needs checklist generated the highest percentage of referrals (27.5%) compared to COST and/or distress thermometer screening.