Evaluating Coverage and Cost of Care Links C4643: FY25 Evaluating CC Links

Abstract Pediatric cancer patients and their caregivers, especially in low-income, rural regions, are at high risk of financial toxicity (FT), the financial burden and stress related to high costs of cancer care. Resources and skills to manage costs, resolve financial and legal barriers, and overcome structural obstacles to healthcare access are either lacking or inequitably distributed. Limitations exist in standardized cancer care delivery approaches to address FT such as oncology financial navigation (OFN) programs, and coaching and education programs to support financial or cost- related literacy of patients and caregivers. Implementing OFN programs can be an effective solution to identify and intervene on health-harming social determinants of health (SDOH) and improve FT of pediatric cancer survivors and their caregivers. The overall goal of this proposed study is to develop and implement CC LinksTele (Coverage and Cost-of-Care Links– Telehealth)– a novel, virtual, multi-level (patient/caregiver and health systems) financial and legal education, coaching, and navigation assistance program designed to reduce FT and improve cost-related health literacy of pediatric cancer patients and their caregivers. The rationale for the proposed research builds on the premise that the early identification of patients/caregivers at risk for FT allows the health system to proactively address the issue by linking the patient/caregiver to needed financial assistance resources, which in turn helps improve patient health outcomes, and increase financial benefits for patients and financial return on investment (ROI) for health systems. For patients and caregivers, the availability of a patient-centered, tailored, education, coaching and navigation program will help increase knowledge, financial literacy, and self- efficacy around managing costs of care and reduce barriers to engaging in cost of care conversations with the healthcare team. For healthcare team members and staff, the availability of an interdisciplinary team to help supply cost information and address financial/legal concerns will help reduce barriers to engaging in cost of care conversations. Furthermore, the virtual platform of CC LinksTele will ensure widespread outreach and accessibility, especially in rural, underserved areas. To support our overall objective, we will conduct a mixed-methods (qualitative – single arm feasibility/acceptability trial) study in three phases. Specifically, we will start with conducting a formative evaluation to assess the contextual factors of the intervention settings (i.e., organizational level policies and characteristics) that may influence implementation of CC LinksTele and to inform necessary modifications to the proposed implementation strategies, pathways, and workflows (Aim 1). We will then train for healthcare team members (systems-level), specifically nurses on screening for financial toxicity, engaging in cost of care conversations, and referring to financial and legal navigation services (Aim 2). Finally, we will evaluate the feasibility and acceptability of CC LinksTele and gather preliminary data on its impact on patient and caregiver-reported financial and health outcomes (Aim 3). In addition, we will also assess the critical facilitators and barriers for the CC LinksTele implementation process and outcomes, future dissemination strategies, and sustainability (secondary aim). The proposed financial navigation program is designed to address patient, caregiver, and system-level factors associated with decreasing cancer-related FT. If effective, we can expand this model to other cancer populations and settings and/or other cancer centers, including those in UK HealthCare’s Markey Cancer Center’s affiliate network that serve rural regions of Kentucky.