Improving Cancer Patients' Insurance Choices

Study Overview
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Brief Summary
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The goal of this research study is to find out if a decision aid (DA) created by investigators, I Can PIC, is effective in helping cancer patients make decisions about their health insurance. The investigators will evaluate I Can PIC compared to an attention control condition (existing website created by the American Cancer Society Cancer Action Network). The study hypothesis is that those randomly assigned to I Can PIC will have higher knowledge about health insurance terms and details, more certainty about the best health insurance plan for them, and more confidence in their health insurance decisions compared to those randomly assigned to the control condition.

Detailed Description
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In a prior study, the investigators created a consumer-friendly online tool, Show Me Health Plans (SMHP), for those enrolling in health insurance in the ACA marketplace. I Can PIC was developed based on SMHP, with input from an advisory board, and incorporating feedback from semi-structured qualitative interviews with cancer survivors. The investigators created I Can PIC to focus on unique needs of cancer patients and survivors considering health insurance. In this study, the investigators will examine the effectiveness of I Can PIC by conducting a randomized experiment with 275 participants. The trial will compare the I Can PIC to an attention control website developed by the American Cancer Society Cancer Action Network. Primary outcomes include knowledge, decision self-efficacy, certainty about plan choice, and the match between plan choice and preferences. The investigators will also explore whether financial toxicity, cancer type, and time since diagnosis relate to outcomes.

Official Title
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Supporting Cancer Survivors' Health Insurance Marketplace Decisions

Conditions
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Cancer, Health Literacy, Health Insurance, Health Services Accessibility, Informed Decision Making

Intervention / Treatment
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* Behavioral: I Can PIC


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Ability to read English Diagnosed with cancer in the past 5 years Residing in Missouri or Illinois Exclusion Criteria: Eligible for Medicaid or Medicare in Missouri or Illinois Enrolled in the following types of health insurance plans: Medicare, Medicaid, TRICARE or other military healthcare, or Indian Health Services

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 64 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: I Can PIC<br>The I Can PIC website will be provided to participants randomized to the experimental/intervention group. | Behavioral: I Can PIC<br>* Participants will be shown (on a computer or via email link) a website called I Can PIC. I Can PIC provides health insurance education, suggests ways to learn about the costs of cancer care and follow-up, shows resources to help offset the high costs of care, and helps individuals estimate (based on national data) how much they might spend on health insurance in the upcoming year.<br>* Other names: Decision Aid (DA);|
| No Intervention: Attention Control<br>Participants randomized to the attention control group will be provided a link to a website developed by the American Cancer Society Cancer Action Network. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Knowledge Score | The percent correct out of eight questions that were created by the research team based on information that is considered vital to making health insurance decisions. | Completed immediately after using I Can PIC | 
| Decision Self-efficacy | The validated decision self-efficacy scale will be used. This 11-item scale measures an individual's self-confidence or belief in their ability to make a decision. Individuals will be asked to rate how confident they feel taking actions involved in making an informed choice (e.g., gathering information, asking questions, and expressing opinions). | Completed immediately after using I Can PIC. | 
| Certainty about Choice (Decisional Conflict Scale) | The validated, 4-item SURE Test for clinical practice will be used. This scale measures whether individuals feel they have enough information to make a choice, are clear about their values for risks and benefits of their choice, and feel they have enough support to make a choice. | Completed immediately after using I Can PIC | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Health Insurance Literacy Measure | Two items from the validated Health Insurance Literacy Measure will be used. This scale measures consumers' confidence in their ability to estimate their annual health care costs and their understanding of health insurance terms. | Completed immediately after using I Can PIC | 
| Health Insurance Literacy Measure | Two items from the validated Health Insurance Literacy Measure will be used. This scale measures consumers' confidence in their ability to estimate their annual health care costs and their understanding of health insurance terms. This measure will be assessed at follow-up to see if differences observed between groups immediately post-intervention, remain at follow-up. | 3 month follow-up | 
| Choice of Health Insurance Plan | Participants will be asked what health insurance plan they would choose. Plan selections will be categorized by the type of plan, e.g., high deductible plan, PPO, silver-tier Marketplace plan, gold-tier Marketplace plan, and will be compared to our algorithmic prediction about good fit plans for users based on estimates of their health care expenses. | Completed immediately after using I Can PIC | 
| Choice of Health Insurance Plan | Participants will be asked what health insurance plan they choose. Plan selections will be categorized by the type of plan, e.g., high deductible plan, PPO, silver-tier Marketplace plan, gold-tier Marketplace plan, and will be compared to our algorithmic prediction about good fit plans for users based on estimates of their health care expenses. This measure will be assessed at follow-up to see if differences observed between groups immediately post-intervention, remain at follow-up. | 3 month follow-up | 
| Healthcare Utlization | Participants will be asked questions about how often they use healthcare services to see if their plan choice relates to their utilization | 3 month follow-up | 
| Knowledge Score | The percent correct out of eight questions that were created by the research team based on information that is considered vital to making health insurance decisions. This measure will be assessed at follow-up to see if differences observed between groups immediately post-intervention, remain at follow-up. | 3 month follow-up | 
| Certainty about Choice (Decisional Conflict Scale) | The validated, 4-item SURE Test for clinical practice will be used. This scale measures whether individuals feel they have enough information to make a choice, are clear about their values for risks and benefits of their choice, and feel they have enough support to make a choice. This measure will be assessed at follow-up to see if differences observed between groups immediately post-intervention, remain at follow-up. | 3 month follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Decision Making, Decision Support, Health Literacy