Oncology financial advocacy services guidelines: Results of a Delphi study.

Abstract

e18606 Background: At least half of people with cancer experience financial toxicity1 but financial advocacy has emerged as a promising intervention to mitigate it. How cancer programs and practices screen for financial toxicity among patients and the types of services they offer vary greatly. Standardization is needed to evaluate the outcomes and impacts of financial advocacy. Therefore, the Association of Community Cancer Centers (ACCC) Financial Advocacy Network set out to develop Oncology Financial Advocacy Services Guidelines (hereafter “the Guidelines”) to address this gap. Methods: To conduct this original, non-clinical trial research, ACCC convened a task force of seven multidisciplinary experts in financial advocacy to oversee a modified Delphi study. The task force assembled a panel of 49 experts, who represented oncology financial advocacy staff, multidisciplinary cancer care team members, financial advocacy subject matter experts, as well as patients and patient advocates. Based on a literature review and qualitative input from panelists, the task force drafted a list of 44 potential guidelines. In early 2022, panelists completed two rounds of anonymous voting, determining if each statement should not be a guideline, be a minimum guideline, or be an enhanced guideline. Consensus was set at 75% agreement. Results: The panel reached consensus that 43 statements should be guidelines. One guideline was rated minimum, while another 17 trended toward being considered minimum (60%-74% agreement among panelists). The panel rated one guideline as enhanced, with two others trending toward being enhanced. Twenty-two guidelines did not reach consensus one way or another on being minimal vs. enhanced. Conclusions: The Guidelines are publicly available in a report that includes implementation considerations extracted from Delphi panelists’ comments and task force input. Half of guidelines did not reach consensus on whether they are minimum or enhanced, reflecting the diversity of current financial advocacy practice and a need to develop greater standardization in the field. ACCC is taking several next steps to advance research and quality practice using the Guidelines, including collaborative policy development, assessment tools, and the creation of valid metrics and accountability measures.