Abstract B095: Financial hardship screening among Native American patients with cancer: A qualitative analysis
Authors: Buettner Amber Anderson , Janitz Amanda , Madison Stefani , Doescher Mark , Harjo Keri , Dartez Stephnie , Bear Marvin , Khoussine Michaela , Rhoades Dorothy 
Published: January 2023

Abstract
Introduction: Cancer-related financial hardship is an increasingly recognized problem for patients, families and caregivers. Many Native American patients, including persons of American Indian or Alaska Native descent, may be at increased risk for cancer-related financial hardship due to highly prevalent factors, such as low income, medical comorbidity, and lack of private health insurance coverage. Methods: We conducted key informant interviews with Native American patients with cancer and clinical staff at a single cancer center. Eligible patients included those who had a confirmed diagnosis of cancer and were referred to the cancer center through the Indian Health Service Purchased and Referred Care Program, Tribal health program, or Urban Indian health program. Eligible clinical staff included physicians, advanced practice providers, and social workers. Patient interviews included questions about current financial hardship, experiences in discussing financial hardship with the cancer care and primary care team, and acceptability of completing a financial hardship screening tool at the cancer center. Clinician interviews focused on confidence, comfort, and experience in discussing financial hardship with patients. Recorded interviews were transcribed and thematically analyzed using MAXQDA® software. Results: A total of seven patients and four clinicians participated in the interviews. Patients expressed many financial challenges to receiving cancer care. The most frequently stated challenges related to transportation from rural parts of the state to the cancer center. Most patients discussed reliance on caregivers for transportation. Some patients also experienced financial challenges related to lodging during treatment, food insecurity, and utility expenses. Patients were willing to complete a financial hardship screening tool, but indicated this tool should be short and not overly intrusive of the patient’s finances. Clinical staff described discomfort in discussing financial hardship with patients, primarily due to a lack of training and knowledge about resources to support patients. There were also differing perspectives on which staff type (social work, Native American patient navigators, or others) were responsible for addressing financial hardship. Conclusions: We identified facilitators and barriers at both the patient and clinician levels to complete a financial hardship screening tool. These preliminary findings suggest that cancer centers need to develop clear organizational structures and processes in order for financial hardship to be addressed effectively. We are currently implementing a screening tool in a pilot study and conducting additional interviews among patients and clinical staff to identify methods to address financial hardship among Native American cancer patients.
Citation Format: Amber Anderson Buettner, Amanda Janitz, Stefani Madison, Mark Doescher, Keri Harjo, Stephnie Dartez, Marvin Bear, Michaela Khoussine, Dorothy Rhoades. Financial hardship screening among Native American patients with cancer: A qualitative analysis [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B095.