Financial Distress Research Articles

Balancing customer and employee orientations: impact on financial distress and firm value

PurposeThis paper investigates the effect of balanced orientation (BO) toward customers and employees on financial distress and firm valuation. Rooted in stakeholder theory and the attention-based theory of firms, the study aims to understand how a balanced synthesis of employee orientation (EO) and customer orientation (CO) influences the long-term market performance and survivability of firms, particularly in the context of emerging markets.Design/methodology/approachA panel dataset of the top 500 firms listed on the National Stock Exchange of India was analyzed using fixed-effect panel models with robust estimators. The Heckman procedure was employed to address selection bias. Financial data were sourced from the CMIE Prowess database and balanced orientation data were extracted from the annual letters to shareholders.FindingsThe study finds that a balanced approach to EO and CO significantly lowers bankruptcy risk and increases firm valuation. Contrary to the traditional dichotomy of EO and CO, BO emerges as a key driver in reducing financial distress and enhancing long-term market performance. Firms embracing multiple strategic orientations outperform those solely focused on customer orientation.Practical implicationsFor emerging market firms facing resource constraints, developing BO is challenging but crucial. This study suggests adopting a sequential or alternating approach to developing EO and CO, which can alleviate bankruptcy risk and improve market valuation even in competitive environments.Originality/valueThis paper contributes to the existing literature by empirically demonstrating the significance of BO in emerging markets. It offers a novel perspective on strategic management, highlighting the importance of balancing customer and employee needs, especially in resource-constrained environments.

Predicting Financial Failure of Public Teaching Hospitals: An Application of Fuzzy Clustering Analysis

Purpose –To develop a novel prediction model and determine the variables that best predict hospitals’ financial failures. Design/methodology/approach –A fuzzy C-means clustering analysis was conducted using financial ratios from MoH Hospitals’ financial databases. Hospital Fuzzy Financial Health Scores (HF-HFS) then were calculated the as the degree of financial failure measured through the selected n-cluster model. Findings –The results show that the number of teaching hospitals experiencing financial failure has increased. HF-FHS scores also were compared with the modified Altman Z scoresa commonly used financial distress measure in the hospital service sector. The HF-FHS scores in good and poor financial conditions differ significantly. The HF-FHS scores were also strongly correlated with the Altman Z scores. Discussion –The rising trend in the number of hospitals experiencing financial difficulties over the years may cause some hospitals in financial distress to fail to fulfill their obligations, which may disrupt the services provided. In such a situation, good management skills, which are the most important factor reducing the financial risks of hospitals, will not work after a certain point.Conclusions –The findings indicate Fuzzy C Means clustering as a viable option to evaluate the financial failure of hospitals compared to more traditional methods such as Altman Z scores. Hospitals still face financial pressures due to market and structural factors such as the global budget repayment system, pricing and collection time, and insufficient competition conditions.Predicting hospitals’ financial failures can help develop managerial policies and strategies to recognize and combat risks, improveperformance, and improve the current situation of hospitals.

Exposure to superstar firms and financial distress

AbstractA few highly successful firms (“superstar firms”) have captured large market shares and earned massive profits in recent decades. We examine whether superstar firms are associated with a greater likelihood of financial distress for firms exposed to them in product markets. Building on recent research, we identify superstars as firms with the highest markups in the industry and whose industry markup share increases over time. We then measure, with product similarity scores, a firm’s overall product market exposure to superstars. We document that firms with greater exposure are more likely to file for bankruptcy. We examine why superstar exposure is associated with bankruptcy and show that firms with the greater superstar exposure exhibit weaker financial performance and greater riskiness. Furthermore, we show that the association between superstar exposure and the likelihood of bankruptcy strengthens when superstars have greater market power.

Emotional Support and Financial Distress

Abstract This paper is the first to explore emotional support as an important determinant of household financial outcomes. Using microdata from the United States and Australia, I document that individuals who feel emotionally supported are less likely to experience financial distress. This relationship is not confounded by nonemotional aspects of social support and is confirmed by between-siblings and within-individual analyses. Further investigation suggests emotional support helps to overcome psychological barriers that impede individuals from taking precautions against adverse shocks. Moreover, when such shocks occur, those with strong emotional support can better cope with the adversity as emotional support boosts their confidence. (JEL D14, D91, G41, G51, Z13)

An updated model of rural hospital financial distress.

To create a model that predicts future financial distress among rural hospitals. The sample included 14,116 yearly observations of 2311 rural hospitals recorded between 2013 and 2019. We randomly separated all sampled hospitals into a training set and test set at the start of our analysis. We used hospital financial performance, government reimbursement, organizational traits, and market characteristics to predict a given hospital's risk of experiencing one of three financial distress outcomes-negative cash flow margin, negative equity, or closure. The model's area under the receiver operating characteristic curve (AUC) equaled 0.87 within the test set, indicating good predictive ability. We classified 30.55% of the observations in our sample as lowest risk of experiencing financial distress over the next 2 years. In comparison, we classified 32.52% of observations as mid-lowest risk of distress, 26.40% of observations as mid-highest risk, and 10.52% of observations as highest risk. Among test set observations classified as lowest-risk, 5.78% experienced negative cash flow margin within 2 years, 1.50% experienced negative equity within 2 years, and zero observations experienced closure within 2 years. Within the highest-risk group, 61.57% of observations experienced negative cash flow margin, 43.02% experienced negative equity, and 3.33% experienced closure. Given the ongoing challenges and consequences of rural hospital unprofitability, there is a clear need for accurate assessments of financial distress risk. The financial distress model can be used by researchers, policymakers, and rural health advocates as a screening tool to identify at-risk rural hospitals for closer monitoring.

Faktor yang Memengaruhi Prinsip Konservatisme Akuntansi di Perusahaan yang Terdaftar di Bursa Efek Indonesia

Financial reports are guidelines used by various parties in making decisions. However, based on the survey, there are several companies that manipulate financial reports for both personal and company interests. One of the things that can cause financial reports to not be in accordance with the actual situation is the accounting method used, such as the application of accounting conservatism. This research was conducted to test the influence of the independent variables consisting of profitability, leverage, financial distress, and managerial ownership on the dependent variable, namely accounting conservatism. The population of this research consists of 305 data from financial sector companies listed on the Indonesia Stock Exchange from 2020 to 2022. Using purposive sampling techniques, only 87 data meet the research sample criteria and will be analyzed in this research. The research uses a multiple linear regression analysis method which aims to test the influence of more than one independent variable on one dependent variable. The results of this research are that profitability, leverage, financial distress, and managerial ownership simultanously influence accounting conservatism. Profitability, financial distress and leverage partially have no effect on accounting conservatism. Meanwhile, managerial ownership partially influences accounting conservatism.

The Intersection of Travel Burdens and Financial Hardship in Cancer Care: A Scoping Review.

In addition to greater delays in cancer screening and greater financial hardship, rural-dwelling cancer patients experience greater costs associated with accessing cancer care, including higher cumulative travel costs. This study aimed to identify and synthesize peer-reviewed research on the cumulative and overlapping costs associated with care access and utilization. A scoping review was conducted to identify relevant studies published after 1995. by searching five electronic databases: PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycInfo, and Healthcare Administration. Eligibility was determined using the PEO (Population, Exposure, and Outcomes) method, with clearly defined populations (cancer patients), exposures (financial hardship, toxicity, or distress; travel-related burdens), and outcomes (treatment access, treatment outcomes, health-related quality of life, and survival/mortality). Study characteristics, methods, and findings were extracted and summarized. Database searches yielded 6,439 results, of which 3,366 were unique citations. Of those, 141 were eligible for full-text review, and 98 studies at the intersection of cancer-related travel burdens and financial hardship were included. Five (5) themes emerged as we extracted from the full-texts of the included articles: (1) Cancer treatment choices, (2) Receipt of guideline-concordant care, (3) Cancer treatment outcomes, (4) Health-related quality of life, and (5) Propensity to participate in clinical trials. This scoping review identifies and summarizes available research at the intersection of intersection of cancer care-related travel burdens and financial hardship. This review will inform the development of future interventions aimed at reducing the negative impacts of cancer-care related costs on patient outcomes and quality of life.

A National Analysis of General Pediatric Inpatient Unit Closures and Openings, 2011-2018.

This paper provides an examination of: (1) the frequency and net rates of change for general pediatric inpatient (GPI) unit closures and openings nationally and by state; (2) how often closures or openings are caused by GPI unit changes only or caused by hospital-level changes; and (3) the relationship between hospital financial status and system ownership and GPI unit closures or openings. This study used the Health Systems and Providers Database (2011-2018) plus 3 data sources on hospital closures. We enumerated GPI unit closures and openings to calculate net rates of change. Multinomial logistic regressions analyzed associations between financial distress, system ownership, and the likelihood of closing or opening a GPI unit, adjusting for hospital characteristics. Across the study period, more GPI units closed th opened for a net closure rate of 2.0% (15.7% [638 of 4069] closures minus 13.7% [558 of 4069] openings). When GPI units closed, 89.0% (568 of 638) did so in a hospital that remained operating. Hospitals with the most financial distress were not more likely to close a GPI unit than those not (odds ratio: 1.01 [95% confidence interval: 0.68-1.50]), but hospitals owned by systems were significantly less likely to close a GPI unit than those not (odds ratio: 0.66 [95% confidence interval: 0.47-0.91]). Overall, more GPI units closed than opened, and closures mostly involved hospitals that otherwise remained operational. A hospital's overall financial distress was not associated with GPI unit closures, whereas being owned by a system was associated with fewer closures.

Baseline financial distress and cost-related social risks among participants in the Cancer Financial Experience (CAFÉ) trial.

172 Background: Cancer Financial Experience (CAFÉ) is a multi-site, three-arm randomized controlled trial to test the impact of a novel financial navigation intervention on financial distress among cancer patients. We compared the baseline prevalence of financial distress among CAFÉ trial participants, using two instruments (InCharge and COST), and assessed cost-related social risks. Methods: Three hundred seventy one (n=371) participants were consented and randomized between August 2021-March 2023. Eligible participants (n=2033) included adults (18+ years of age), diagnosed with invasive cancer within 120 prior to a recent visit to a CAFÉ study clinic/site, members of Kaiser Permanente Northwest or Kaiser Permanente Washington, and spoke English or Spanish. Following consent, participants were randomized to one of three trial arms: enhanced usual care; brief intervention; enhanced intervention. The two primary trial outcomes were: financial distress, measured using the InCharge Financial Distress/Financial Well-Being scale, and cancer-specific health-related quality of life, measured by the FACT-G7 scale. Additionally, we collected the COST measure and cost-related social risks. All participant-reported outcomes, demographic, and socioeconomic data were collected via telephone survey at baseline and 12 months by trained interviewers. Survey data was stored in REDCap. Descriptive statistics were used to assess participant demographic, socioeconomic, and outcome data at baseline. Results: Among randomized participants (n=371), mean age was 61 years (standard deviation=14 years), 63% were female, 11% Hispanic, 9% Asian, 8% Black , 61% married or living with partner, 31% were employed full-time, 37% retired, 44% had annual income of $20000-$74999, 45% had Medicare, and 38% had breast cancer. At baseline, InCharge scores showed 31% (n=113) of participants had high, 19% had moderate, and 50% had low financial distress. Based on COST scores, 2.2% (n=16) of participants had high, 63% had moderate, and 39% had low financial distress. Forty percent (n=148) of participants reported any cost-related social risk, including heat and electricity (15%) and housing (15%). Conclusions: Baseline findings from the CAFÉ trial indicate that nearly one-third of patients with cancer may have high financial distress around the time of diagnosis, though this may vary by screening tool. The ideal screening tool for use at diagnosis is worthy of further study. Assessing and assisting patients with social risks, including financial distress, is essential to advancing cancer health equity. Clinical trial information: NCT05018000 .

Related party transactions and financial distress: role of governance and audit attributes

Purpose This study aims to investigate the relationship between related party transactions (RPTs), specifically sales and purchases, and financial distress. It also explores the moderating role of various corporate governance mechanisms and audit-firm characteristics in this relationship. Design/methodology/approach This study spans the period before and during the COVID-19 pandemic and uses a logistic regression model focusing on an eight-year noncylindrical panel data set, covering a sample of Omani listed companies from 2014 to 2021. Findings The empirical findings reveal a contrasting relationship between RPT sales and financial distress: a significant negative relationship in the postpandemic period, and a positive relationship in the prepandemic period. Conversely, RPT purchases exhibit a consistently significant positive relationship across all periods. The presence of a Big Four audit-firm and audit delay are notable moderating variables associated with audit-firm attributes. Additionally, the board’s review of RPT transactions, size, meetings and independence are significant moderator variables pertaining to corporate governance. Research limitations/implications This study provides empirical evidence to inform regulators of the efficiency and opportunistic aspects of RPTs in relation to financial distress. The study’s findings offer valuable guidance to managers by suggesting ways to reinforce corporate governance practices and strengthen audit mechanisms to counteract the negative consequences of RPTs. Originality/value To the best of the author’s knowledge, this study is the first to explore the direct relationship between both RPT sales and purchases and financial distress while also examining the moderating effect of corporate governance and audit attributes. This comprehensive approach distinguishes itself from its unique contributions to the field.

Baseline characteristics of parents enrolled in ACCL20N1CD: Financial distress during treatment for pediatric acute lymphoblastic leukemia (ALL) in the US.

220 Background: Personal costs of childhood cancer can contribute to disparities in health outcomes. The purpose of ACCL20N1CD is to examine trajectories of parental costs and the associated financial distress, cost coping behaviors, and household material hardships (HMH) during treatment for pediatric ALL. Objective is to report baseline characteristics of the parents and their households. Methods: The study used a prospective cohort design with repeated measures. Setting was Children’s Oncology Group (COG) practices at National Cancer Institute Community Oncology Research Program (NCORP) institutions. Parents who use English or Spanish, and have children newly diagnosed with ALL treated at COG NCORP practices were eligible. Parents were asked to complete surveys at 3 time points, including baseline (T1; during induction and <7 days after planned induction remission evaluation). Surveys included items about (a) parent socio‐economic status, financial distress measured by 8-item Personal Wellness Scale (PFWS), and cost coping behaviors, and (b) HMH. Factors related to high PFWS scores were evaluated by logistic regression. Results: Of 104 evaluable parents, most were female (83.7%), white (65.4%), non-Hispanic (48.1%), partnered (79.8%), > high school diploma (93.3%), used English (84.6%), worked full (48.1%) or part (5.8%) time, and paid for their child’s care with public insurance (57.7%). Median household income=$50,000 (Inter-Quartile Range/IQR 20,000-100,000) for 4 (IQR 4-5) people. Not including wages lost due to caregiving, out of pocket payments for medical care + other ALL-related costs in the prior month >15% of monthly income for 51.9% of households, which is considered financially catastrophic. 24.0% of households lacked food stability; 21% had housing insecurity. Conclusions: At baseline, sizeable proportions of parents exhibit high out of pocket costs, high financial distress level, and multiple cost coping behaviors with implications for future health and individual and household quality of life.

Improving the detection and documentation of patients’ symptoms in an integrated gastrointestinal oncology and palliative care clinic.

336 Background: Patients with gastrointestinal (GI) malignancies experience a high burden of disease-related symptoms and treatment side effects. We established an integrated GI oncology and palliative care (PC) clinic in which a PC physician is co-located with the oncology team and can provide timely response to patient distress and facilitate communication with the interdisciplinary palliative care team. Yet, even in the integrated clinic, patient symptoms were unreliably assessed, leading to missed opportunities to address patient suffering. Between October 2023 and January 2024 for patients seen in-person in the integrated clinic for oncology or PC visits, the median rate of symptom documentation was 45%. Emotional, financial, and spiritual distress documentation rates were lowest. We hypothesized that by implementing a systematic, comprehensive patient-reported symptom assessment tool, we could increase the detection and documentation of symptoms, and in turn, improve communication around patient distress and timely response to symptoms. Methods: We measured the rate of symptom documentation (primary outcome) and the use of a patient-reported symptom assessment tool for adults with GI cancers seen in-person in the integrated clinic in Spring 2024. Based on the Edmonton Symptom Assessment Scale (ESAS) and expert consensus, we determined which symptoms were most important to identify. Documentation rates were assessed via manual chart review of visit notes and flowsheet data. Prospective post-intervention data (March to May 2024) were compared to retrospective pre-intervention baseline data (October 2023 to January 2024). Interventions included modification of the ESAS to include GI oncology-specific symptoms, implementation of the tool in paper format to encourage patient-clinician communication, frequent staff education and feedback sessions, creation and dissemination of a resource guide for clinicians to respond to identified distress, and patient satisfaction surveys. Results: 126 patients were included in the study (31 pre-intervention and 95 post-intervention). During the post-intervention period, the median rate of symptom documentation increased from 45% to 83% and the median rate of ESAS survey completion increased from 9% to 68%. Documentation of financial and spiritual distress increased from 13% to 71%, for both, and documentation of emotional distress increased from 35% to 72%. On satisfaction surveys (N=20), most patients reported the tool was helpful in sharing their symptoms (70%), was easy to read and understand (100%), and that their clinician was engaged in addressing their symptoms (67%). Conclusions: The implementation of a patient-reported symptom assessment tool in an integrated GI oncology/PC clinic increased documentation of important symptoms, potentially increasing clinician awareness of patient distress.

Baseline practice-level financial screening processes and resources among Children’s Oncology Group National Cancer Institute Community Oncology Research Programs (NCORP).

34 Background: Financial toxicity is an increasingly recognized and prevalent adverse effect during cancer treatment. Systematic financial screening is recommended for families of children with cancer, and emerging data support the importance of system-level support and interventions to mitigate financial toxicity. Financial distress is a key, measurable domain of financial toxicity. Methods: To inform interventions for pediatric oncology settings, we are conducting ACCL20N1CD, a Children’s Oncology Group (COG) prospective, multilevel observational study among NCORP practices in the US, to determine the risk and trajectory for financial distress in guardians of children with newly diagnosed acute lymphoblastic leukemia. We analyzed baseline survey data from COG NCORP practices that enrolled at least one parent. Data were collected via REDCap following the practice’s first parent enrollment. We describe practice participation patterns, current approaches to financial screening, and available resources to address identified needs including navigation. Results: Of 50 eligible COG NCORP practices, 40 (80%) activated the study, and 28 (56%) enrolled at least 1 participant and thus, completed the survey. Most (61%) of these practices treated 50-99 new pediatric oncology patients annually; 10 (36%) enrolled at least 5 participants in ACCL20N1CD. Twenty (71%) reported that their practice routinely conducted financial screening in addition to insurance assessment; 15 (75%) of these 20 practices conducted financial screening at more than one timepoint. Social workers were primarily responsible for screening (16/20; 80%). Only three practices (3/28; 11%) used a standardized financial screening tool. Most practices had access to a private foundation/organization (25/28, 89%), institutional support (23/28, 82%), or local referrals to organizations (22/28, 78%) that provided financial support for patients/families. Fewer practices had patient navigators (9/28, 32%), financial navigators (8/28, 28%), or legal advocates (3/28, 11%) available to assist families. Conclusions: Though most COG practices treating children of parents enrolled in 20N1CD conduct financial screening, processes are not standardized, and resources available to address identified needs and potentially mitigate financial toxicity vary. Further, these data represent enrolling sites which may overestimate screening practices within COG NCORP practices. Variations in financial screening procedures and lack of individual-level resources to facilitate screening may impact delivery of equitable high-quality cancer care across NCORP COG practices. Clinical trial information: NCT04928599 .

The tipping point: Financial and emotional costs of care for Medicare patients with cancer.

260 Background: As cancer-related health care expenses are increasing, a greater proportion of treatment costs are shifting directly to the patient, resulting in an increased financial burden for many patients. In addition to growing healthcare costs, the inflationary environment in the US has also increased the costs of daily living expenses. Although the Inflation Reduction Act (IRA) encompasses measures for negotiating prices of specific high-cost medications within Medicare Parts B and D, given the expenses associated with cancer treatment IRA negotiation provisions will likely have limited impact on patients’ financial burden. We sought to capture the financial and emotional experiences of Medicare cancer patients about their costs of care prior to the implementation of the IRA. Methods: This cross-sectional analysis used data from a nationwide survey distributed in February 2024 by Patient Advocate Foundation (PAF). Inclusion criteria included a valid email address, age >19, self-reported cancer diagnosis and Medicare coverage. Frequencies were calculated for categorical variables. Additional information about financial challenges will be collected on a subset of cancer survey respondents in May 2024. Results: A total of 331 survey respondents with cancer completed the survey. Most respondents were female (61%), age≥56 (86%), white (73%), retired (59%), married (47%), household income <$48,000 (69%), and rural location (24%). The most common cancer types were multiple myeloma (47%) and breast (26%); 25% were diagnosed < 2 years prior, 87% were receiving cancer treatment and 52% experienced financial challenges prior to diagnosis. Almost half (45%) reported a negative change in their financial situation in the past 12 months; caused by increased living (63%), food (60%), medical care (47%) and medication (39%) costs. Overwhelming/above average financial stress (40%) was reported on the day of the survey; 30% reported spending at least 25% of their monthly income on medical costs; 69% reported financial burden due to their illness. Fifty-nine percent reported that finances impacted their emotional wellbeing. Common coping strategies to alleviate financial distress included positive attitudes, family/friend support and spiritual beliefs. Conclusions: To mitigate the impact of inflation on low-income cancer patients, it is essential for policymakers, healthcare providers, and community organizations to work together to ensure access to affordable healthcare, support services, and financial assistance programs. Additionally, raising awareness about the challenges faced by this vulnerable population and advocating for policies that address their needs can help alleviate some of the burdens imposed by inflation. While the IRA is a step in the right direction, its financial impact on patients appears limited.

Assessing workforce trends and needs for oncology financial advocacy programs.

25 Background: Financial advocates (also known as navigators/counselors) are an increasingly important role on the multidisciplinary team to improve equitable access to care by assessing and addressing risks of financial distress for people with cancer and their families. The Association of Cancer Care Centers (ACCC) recently published consensus-driven guidelines for delivering financial advocacy (FA) services, but the field still lacks standard definition of roles, responsibilities, metrics, and benchmarks. ACCC’s Financial Advocacy Network Census survey provides an opportunity to monitor FA workforce trends over time. Methods: ACCC worked with an expert multidisciplinary committee to guide development of a Census survey. It was distributed electronically via Qualtrics to a subset of ACCC members (clinical and non-clinical staff involved in delivering FA services) in May-June 2023. Exploratory analysis was performed on 2023 Census data and results were compared to 2019-2020 Census data. Results: 95 respondents representing 70 unique cancer centers participated in the 2023 Census, compared respondents from 153 unique in 2019-20. Sample size varied between the two time points due to length of recruitment time. Most respondents were financial advocates (36% in 2023 vs 53% in 2019-20), followed by administrators (34% 3%), and nurses/nurse navigators (14% vs 21reported that their cancer center did not have any dedicated financial advocates (4% vs 10%). There was a decrease in the percentage of respondents reporting that their current level of FA staffing was sufficient to meet patient demand (13% vs 30%). A smaller proportion of respondents indicated that their cancer center did not track any FA metrics (17% vs 23%). More respondents reported receiving formal FA training (77% vs 30%). Conclusions: Despite variability in sample size across the Census time points, the trends are clear. There is growth in FA staffing since 2019, but patient demand for FA services appears to have outpaced workforce growth. There appears to be increased tracking of the impact of FA services, which can be used to support the business case for additional staff. Cancer centers can use ACCC’s FA Services Guidelines and corresponding assessment tool to measure how their current level of service delivery aligns with expert guidelines and specific standards for program metrics and training. Engagement in formal FA training has increased substantially, but an opportunity remains to reach more staff that support FA services to provide training (eg ACCC’s Financial Advocacy Network Boot Camp).

Labor Unionization and Trade Credit: A Regression Discontinuity Design

This paper examines how labor unionization affects suppliers’ trade credit provisions. Using a regression discontinuity design based on close-call NLRB union elections, we find that firms narrowly passing union elections experience a significant decrease in trade credit from suppliers. This effect is attenuated in right-to-work states and for firms with better financial performance. These findings suggest that suppliers view unionization as a risk factor on labor costs, financial distress likelihood, and reduced operational flexibility. Overall, this paper adds to the literature on labor unions’ economic impacts, determinants of trade credit, and the interactions between different corporate claim holders.

Patient engagement in a community-partnered hybrid health-related social needs navigation intervention for adolescents and young adults with cancer (AYA-NAV).

173 Background: Adolescent and young adult (AYAs) cancer survivors experience high rates of financial toxicity (FT), which is associated with poorer health outcomes. FT may disproportionately affect AYAs with unmet health-related social needs (HRSN), such as food or housing insecurity. Needs navigation may be an effective intervention to reduce financial distress, however, engagement has been a challenge in prior adult-directed interventions. We hypothesize that a hybrid navigation delivery model with community organization support and digital delivery will reduce financial distress and improve health outcomes. In a pilot study of AYA-NAV, an AYA-directed needs navigation intervention, we report patient engagement among participants. Methods: Eligible AYAs were 15-39 years old, Spanish- or English-speaking, receiving curative-intent treatment for cancer, and screened positive for FT (Comprehensive Score of Financial Toxicity < 22) or unmet HRSN (food, housing, transportation, or utilities insecurity). Participants were referred for a consultation with the Patient Advocate Foundation (PAF), a national organization that provides case management and navigation support for people facing life limiting illness. At month 1, participants were referred to findhelp.org, a digital platform of comprehensive resources to facilitate resolution of unmet HRSN. Monthly check-ins were conducted by the study team to assess acceptability, intervention fidelity, and provide additional navigation support. We plan to enroll 30 participants on this study. Results: Of 19 AYAs that completed screening to date, 13 met criteria for FT or unmet HRSN; 13 (100%) agreed to AYA-NAV participation. To date, of 46 check-ins initiated by the study team, 33 (72%) were completed. All AYAs connected with the study team at least once during the 6-month duration of the study by text, phone, and/or in-clinic. Ten out of 13 (77%) participants reported that they spoke with a PAF case manager, and 7 (70%) of those said it was helpful. If the patient was unable to connect with PAF, more than half (55%) requested to be reconnected during a monthly check-in. Eight of the 13 (62%) participants visited findhelp.org; 6 (75%) of those found the digital platform to be helpful. Most patients referenced the high usability of findhelp.org, and 55% stated they connected to community resources via findhelp.org. Patients qualitatively reported challenges to intervention participation including medical complications, scheduling conflicts, and work commitments. Conclusions: Preliminary data demonstrate high patient engagement and intervention fidelity during a pilot feasibility study of AYA-NAV. Flexible modes for data collection and intervention delivery are important to inclusion of and retention of AYAs in hybrid navigation delivery models. Clinical trial information: NCT06072833 .

Peran Penghindaran Kebangkrutan dalam Mengakselerasi Earning Management

This study aims to analyze the impact of financial distress on earnings management within companies listed on the Indonesia Stock Exchange (IDX) from 2019 to 2021. Utilizing a purposive sampling technique, the research focuses on 44 companies that are noted for their special status on the IDX. Key control variables examined include company size, leverage, cash flow operations (CFO), growth, profitability ratios (ROA), equity issuance (EISSUE), and debt issuance (DISSUE). The findings reveal that financial distress significantly and negatively influences earnings management, indicating that distressed companies are less likely to engage in manipulative financial reporting. Furthermore, the study identifies that all control variables contribute to a nuanced relationship between financial distress and earnings management. Specifically, variables such as size, CFO, leverage, ROA, EISSUE, and DISSUE exhibit a significant positive impact on earnings management, suggesting that larger companies with higher leverage and profitability are more prone to earnings manipulation. Conversely, the growth variable demonstrates a significant negative effect, implying that companies experiencing growth are less likely to manage earnings. These insights contribute to a deeper understanding of the dynamics between financial distress and corporate financial behavior, offering valuable implications for investors, regulators, and policymakers.

Determinasi Integritas Laporan Keuangan

Financial Statements are a form of corporate management responsibility aimed to stakeholders. The presentation of financial reports must be carried out accurately and free from misstatements in the preparation process. In other words, financial statements must have quality or integrity in its composition. The aim of this research is to determine the influence of company size, financial distress, independent commissioners, and public accounting firm size on the integrity of financial statements in infrastructure sector companies with profitability as a control variable. This research is quantitative research using secondary data from audited financial statements and company annual reports. Based on the results of the tests, it is concluded that 1) company size has no effect on the integrity of financial statements; 2) financial distress has no effect on the integrity of financial statements; 3) independent commissioners have a positive influence on the integrity of financial statements; 4) public accounting firm siz has a positive effect on the integrity of financial statements.

Dynamics of Corporate Finance Research in Global Scientific Literature

This study explores the dynamics of corporate finance research in global scientific literature from 2000 to 2024 using a bibliometric approach. By analyzing keyword co-occurrence and citation data, the research identifies key themes, emerging trends, and influential contributors in corporate finance. Core topics such as capital structure, cost management, and debt remain central, reflecting traditional corporate finance priorities. However, newer areas, including corporate social responsibility (CSR), corporate cash holdings, and behavioral finance, have gained prominence, signaling a shift towards integrating non-financial factors into corporate strategies. The study also highlights the lasting impact of global financial crises, particularly the 2008 crisis, on shaping research in financial distress, risk management, and institutional roles. These insights provide a comprehensive overview of the evolution of corporate finance research and offer directions for future studies.