Leveraging Medical-Legal Partnerships to Enhance Patient-Centered, Team-Based Conversations with Pediatric Oncology Patients and Families

Health and social service providers play a central role in facilitating cost of care conversations that help patients manage financial barriers to access by addressing the social determinants of health. An essential component to reducing patient financial burden and improving health outcomes is the integration of health and social services at the point of care to assist patients with physical and psychosocial needs. Medical-legal partnerships (MLPs) are a prime example of this seamless integration and are designed to combine the expertise of lawyers or patient legal advocates into health care settings to assist the healthcare team to address health inequities that are rooted in/created by underlying structural barriers. These advocates serve as third-party, community partners, solely representing patients around issues of education, family law, housing, health and disability insurance, etc. Existing evidence on team-based approaches to enhancing cost of care conversations while leveraging the use of patient legal advocates via MLP is limited. While clinicians and financial navigators can help initiate conversations about costs and connect patients to resources, they are limited in their ability to advocate for patients beyond their role within the health care system. Patient legal advocates are uniquely positioned to assist, advocate for and empower patients with the tools and resources to address various social determinants of health. We propose to develop and test the impact of FINassist (Financial & Insurance Navigation Assistance), an interdisciplinary, team-based approach to enhancing cost of care conversations, improving patient trust and health outcomes, and reducing financial toxicity. Using a mixed method approach, we will determine current methods of Identify best practices and successful models of integrating MLPs in team-based approaches to addressing cost of care conversations and examine patient and provider perspectives on engaging interdisciplinary team-based in this process. Based on qualitative findings and guided by our study advisory board (see below), we will develop and test our intervention to examine its impact on patient-provider trust, health related quality of life, financial toxicity. Findings from this study can significantly increase understanding of how we can better leverage MLPs in interdisciplinary, team-based approaches to having cost of care conversations. It will also help us understand the impact of this approach on promoting equitable access to financial resources, addressing unmet social needs, and improving patient outcomes.