Table 1.

Examples of research questions addressing gaps in understanding of medical financial hardship in cancer survivors

Level of frameworkExample questions
Patient and familyWhat are the strongest risk factors for financial hardship in patients and caregivers (e.g., socioeconomic characteristics, employer accommodations, health insurance coverage and benefit design, health insurance literacy, and clinical factors)? Which risk factors for financial hardship are potentially modifiable and thus could be addressed through intervention? What are the relationships between medical financial hardship and nonmedical aspects of financial hardship, such as food and housing insecurity? What are the associations between medical and nonmedical hardship and health outcomes? What is the trajectory of financial hardship following diagnosis for patients and caregivers? Does the trajectory vary for material, psychologic, and behavioral hardship?
Provider and care teamWhat are key provider and care team factors associated with higher prevalence of patient financial hardship (e.g., age, year of medical school graduation, training and specialty, geographic region, and practice setting)? Is EHR integration and use of system supports in practice associated with financial hardship? What are key barriers to full discussions of treatment costs, benefits, and effects on ability to maintain employment? Does perception of importance of financial hardship and referral to resources differ by provider specialty, training, patient volume, and other factors? Who is the best member of the provider team to discuss financial hardship? Is having a designated team member address treatment costs in practice associated with reduced prevalence of hardship?
Health care systemWhat are key health care system features associated with higher prevalence of patient financial hardship (e.g., breadth and depth of provider networks, benefit design, routine use of EHR functionality in quality improvement, and financial assistance infrastructure)? What aspects of health insurance benefit design are most important? What is the role of transparency of treatment cost and benefit in minimizing financial hardship? Is financial assistance infrastructure associated with reduced prevalence of hardship?
EmployerHow does the prevalence of financial hardship among cancer survivors vary by employer features (e.g., health insurance coverage, paid and unpaid sick leave, workplace accommodations)? What is the role of benefit design for self-insured employers in development of financial hardship?
State and national policyHow do state-level policies, such as Medicaid eligibility threshold and expansion status, affect financial hardship? How do policies related to generic substitution, cost transparency, and oral parity affect financial hardship? Do policies related to availability of Marketplace coverage, essential health benefits, or elimination pre-existing coverage exclusions affect hardship?