Improving Health Insurance Experiences for Adolescent and Young Adult Cancer Patients

Not Applicable

Completed

Conditions: Cancer
Young Adult
Adolescent

Interventions: Behavioral: Health Insurance Education Program (HIEP)
Other: Usual Care

Registration Number: NCT04448678

Lead Sponsor: University of Utah

Brief Summary: This is a test of an existing health insurance education program (HIEP) in adolescent and young adult (AYA) individuals (aged 18-39) diagnosed with cancer. The study will evaluate whether the HIEP delivered by patient navigators improves participants' health insurance and cost-related literacy compared to usual navigation care, which does not include education on insurance and medical costs. The study team hypothesizes that: The HIEP will improve participants' health insurance and cost-related literacy compared to usual navigation care. Specifically, that participants in the intervention arm will report greater 1) health insurance and cost literacy, including confidence with provider communication about costs, 2) familiarity with ACA policies, and 3) improvement in financial distress related to medical costs. Participants will fill out a survey upon enrollment and a follow up survey 3 months after meeting with a patient navigator where they may or may not receive the HIEP.

Detailed Description: The goal of this research is to refine and pilot test an existing health insurance education program (HIEP) to improve health insurance and cost-related literacy among adolescent and young adult (AYA) individuals who have recently been diagnosed with cancer. This study will be conducted within the Huntsman-Intermountain Adolescent and Young Adult (HI-AYA) Cancer Care Program, which is a unique collaboration between the Huntsman Cancer Institute and Intermountain Healthcare, the largest oncology providers in Utah. Initially, age-related differences related to health insurance and cost literacy among AYAs diagnosed with cancer ages 18-26 and 27-39 years will be identified, and the HIEP materials will be adapted accordingly. The HIEP delivered by the HI-AYA patient navigators, will be investigated to see if it improves participants' health insurance and cost-related literacy.

Upon enrollment, participants will fill out a survey containing questions about their current health insurance plan, financial status, demographics, health insurance knowledge, and financial toxicity. Participants will then be randomized into separate trial arms after which participants in both groups will meet with a HI-AYA patient navigator. Participants in the interventional arm will receive 4 educational sessions surrounding health insurance use and laws (four sessions total occurring approximately every two weeks). These educational sessions will be conducted, in person, over video conference calls, or over the telephone, and will cover:

* health insurance terms and concepts

* insurance coverage (insurance cards, bills, schedule and explanation on benefits)

* health insurance laws, rights and the appeals process

* budgeting and resources. These sessions will be scheduled with each participant according to their availability, with the goal of meeting every other week.

Approximately three months after meeting with the patient navigator, participants in both arms of the trial will fill out a second survey, including similar questions to those in the first survey as well as questions surrounding satisfaction with the HIEP and the patient navigator delivery for those who received the HIEP. After the post survey is complete, a small subset of participants in both the intervention and control arm will be randomly selected to complete an interview to better understand satisfaction with patient navigation, the intervention, recommendations for modifications on delivery modality, and recommendations for intervention topics and content modifications to identify components of the HIEP that require refinement prior to potential scaling of the intervention to a larger sample. Another small subset of participants will be randomly selected to complete an interview from the control arm to discuss their satisfaction with their patient navigation and to ask how they found resources concerning health insurance during their treatment.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 86

Inclusion Criteria

Were diagnosed with cancer between the ages of 18 and 39 AND
Are within 1 year of a cancer diagnosis AND
Are actively receiving chemotherapy, surgery, radiation, and/or hormonal therapy AND
Are currently insured AND
A patient at Primary Children's Hospital, Intermountain Medical Center or Huntsman Cancer Institute AND
Speak English AND
Have access to an electronic device compatible with video conferencing (e.g., smartphone, laptop, etc.).

Exclusion Criteria

Are unable to participate due to developmental delay OR
Speak a language other than English OR
Are currently uninsured OR
Do not have access to an electronic device compatible with video conferencing (e.g., smartphone, laptop, etc.).

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
HIEP intervention	Health Insurance Education Program (HIEP)	Participants will be randomized to receive the insurance navigation intervention from patient navigators, which includes four, one hour long, educational learning sessions. Randomization will be done by age at diagnosis and site.
Usual Care	Usual Care	Participants will be randomized to receive standard navigation provided by patient navigators ("usual care").

Primary Outcome Measures

Name	Time	Method
Feasibility Measurement	Post-Assessment survey (Weeks 13 (+/- 2 weeks))	Comparing total number of individuals enrolled and randomized vs completed study (completion of both surveys for control or both surveys and all of the sessions for intervention.)
Acceptability - Module Satisfaction	Post-Assessment interview (Weeks 18 (+/- 2 weeks))	Questions surrounding satisfaction with the HIEP. These will be asked at the post-assessment interview and will consist of participants responses surrounding satisfaction with the HIEP. We will report percentages of participants who did 1 or more session and reported satisfaction with the HIEP.
Navigator Satisfaction	Post-Assessment survey (Weeks 13 (+/- 2 weeks))	Validated Patient Satisfaction with Navigator Interpersonal Relationship (PSN-I) measure at post assessment survey. This score ranges from 0-45 with higher scores indicating higher satisfaction. We will report the mean and standard deviation.

Secondary Outcome Measures

Name	Time	Method
Changes in Efficacy-Financial Distress	Baseline (Week 0) and Post Assessment survey ( Weeks 13 (+/- 2 weeks))	Differences between COmprehensive Score for financial Toxicity (COST) reported at the baseline and post-assessment survey. Values range from 0 to 44 where lower COST scores indicate worse financial toxicity. Differences will be examined by age group and by treatment arm. We will report mean and standard deviation. Please note that not all participants, filled out all necessary questions at both timepoints to be assessed.
Changes in Efficacy- Health Insurance Literacy	Baseline (Week 0) and Post Assessment survey (Weeks 13 (+/- 2 weeks))	Differences between Health Insurance Literacy Measure (HILM) reported at the intro baseline and exit post-assessment survey. For this study, the last two sections (3\&4) of the HILM were used. Scores range from 9-36 with lower scores indicate lower health insurance literacy and worse outcomes. Differences will be examined by age group and by treatment arm. We report mean and standard deviation. Please note that not all participants, filled out all necessary questions at both timepoints to be assessed.
Changes in Efficacy- Affordable Care Act (ACA) Familiarity	Baseline (Week 0) and Post Assessment survey (Weeks 13 (+/- 2 weeks))	Questions surrounding familiarity with the ACA reported at the baseline and post-assessment survey. Values range from 0 to 28 with higher scores indicating better familiarity with ACA concepts. We will report the mean and standard deviation of the difference in response scores between baseline and post assessment for the control and intervention. Please note that not all participants, filled out all necessary questions at both timepoints to be assessed.

Trial Locations

Locations (3): Intermountain Medical Center
🇺🇸
Murray, Utah, United States
Primary Children's Hospital
🇺🇸
Salt Lake City, Utah, United States
Huntsman Cancer Institute
🇺🇸
Salt Lake City, Utah, United States