Clinical trial NCT05527392: Virtual Health Insurance Navigation Pilot Program for Childhood Survivors (HINTII)
Official title: Assessing the Effect of Virtual Navigation Interventions to Improve Health Insurance Literacy and Decrease Financial Burden: A Childhood Cancer Survivor Study Randomized Trial (HINTII)
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Childhood Cancer Survivors
Keywords: Health Insurance
Survivorship
Lead sponsor: Massachusetts General Hospital
Sponsor class: OTHER
First posted: 2022-09-02
Enrollment: 520
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Enhanced Usual Care HINT Synchronous Intervention Group HINT Asynchronous Intervention Group
Primary purpose: TREATMENT

Brief summary: The investigators are conducting a Type I hybrid effectiveness-implementation trial to assess the effectiveness of HINT-S (synchronous) compared to enhanced usual care (EUC) in promoting health insurance literacy, thus reducing worry, unmet health care needs, and financial consequences due to medical costs to improve care and long-term outcomes of childhood cancer survivors. The investigators will also compare HINT-S to HINT-A (asynchronous), a prerecorded, asynchronous version of the 5 HINT-S navigator sessions.

Detailed description: The present study seeks to evaluate a health insurance navigation program with childhood cancer survivors recruited from the Long-Term Follow-Up (LTFU) Cohort. Childhood cancer survivors face health challenges throughout their lives that require monitoring and ongoing care. This is compounded by the tendency among childhood survivors to have higher rates of underinsurance, unmet healthcare needs, and burdensome costs related to care. These burdensome costs also contribute to underutilization of care among survivors. Dr. Park and her colleagues published findings that suggested LTFU survivors had difficulty in understanding how to use their insurance, and often experienced financial-related distress. Understanding and navigating insurance benefits in the current landscape is crucial for cancer survivors to obtain and utilize the health care that they need. With this in mind, the study investigators propose to evaluate the effectiveness of an insurance navigation intervention with LTFU participants, delivered in a synchronous and asynchronous modality.

The navigation intervention will be delivered by a health insurance navigator via HIPAA-compliant videoconferencing for the synchronous group (HINT-S) and will be delivered via pre-recorded video session for the asynchronous group HINT-A). Participants will be randomized into either the two navigation intervention arms (HINT-S and HINT-A; approximately 234 per intervention arm), or the enhanced usual care arm (approximately 52 for control arm). The sample size per arm was chosen to enable evaluation of feasibility and acceptability goals, as well as to explore meaningful differences in the outcomes. To assess the proposed primary and secondary outcomes, all trial participants will complete a baseline and 6-month and 12-month post-program follow-up survey.

Eligibility criteria: Inclusion Criteria:

* are 18 years or older at time of enrollment
* are able to give informed consent
* have access to a smartphone, computer, or tablet with internet access
* have US based health insurance
* current LTFU cohort participants
* having access to the CCSS patient portal.

Exclusion Criteria:

* Participants from the pilot trial will not be eligible

Primary outcomes:
measure: Change in Health Insurance Literacy from baseline to 6 months.
timeFrame: 6 months follow up
Secondary outcomes:
measure: Change in Health Insurance Literacy from baseline to 12 months.
timeFrame: 12 months follow up
measure: Change in self-reported financial hardship from baseline to 12 months.
timeFrame: 12 months follow up
measure: Change in annual out-of-pocket costs from baseline to 12 months.
timeFrame: 12 months follow up
measure: Change in the number of Health Care Visits and Procedures (health care utilization) from baseline to 12 months.
timeFrame: 12 months follow up
Other outcomes:
Locations:
city: Boston
country: United States
facility: Massachusetts General Hospital
state: Massachusetts
Study officials:
affiliation: MGH
name: Elyse R Park, Ph.D., MPH
role: PRINCIPAL_INVESTIGATOR
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