Improving Affordability in Cancer Care through Economic Screening and Support (I-ACCESS)

Abstract Improving Affordability in Cancer Care through Economic Screening and Support (I-ACCESS) is a proposed screening assessment and referral program to proactively identify cancer-related financial hardship in patients with cancer at diverse clinical settings and connect those at-risk with education, counseling, and resources. The objective of this study is to pilot and refine I-ACCESS across diverse clinical practice settings to yield a process that directly aligns with consensus standards of care and practice guidelines to assess patients for financial hardship and provide financial resources and support. In Aim 1, we will characterize the context of the context of geographically and demographically diverse clinical practice settings to prepare for I-ACCESS implementation through interviews with up to 30 clinical leaders and frontline staff. Assessment constructs will focus on understanding structural characteristics (including information technology infrastructure), available resources, culture, compatibility, relational connections, communications, and access to knowledge. These data will inform the creation of tailored process maps to outline processes and procedures to prepare each site for I-ACCESS implementation and elucidate when, how, and by whom I-ACCESS screening should be done. In Aim 2, we will implement I-ACCESS and determine the effectiveness of the screening tool in facilitating patient referrals for financial hardship counseling. Using a pre-/post-approach, we will examine whether I- ACCESS screening increases the number of financial counseling and oncology social work referrals (primary outcome) within two large healthcare systems and a network of community-based practices. We will also examine counseling dispositions, receipt of services among those referred to financial support, and the predictive accuracy of the screening tool (secondary outcomes). In Aim 3, we will assess the implementation of I-ACCESS across diverse clinical practice settings using a sequential mixed-methods, multi-stakeholder evaluation. Informed by the Practical, Robust, Implementation and Sustainability Model (PRISM) framework, we will analyze approximately 225 patient and 25 clinician surveys to gather feedback on I-ACCESS delivery, procedures, and barriers/facilitators to implementation. Based upon survey findings, we will then focus on key implementation determinants and outcomes through in-depth, semi-structured interviews with up to 40 stakeholders. Stakeholders will include patients, caregivers, healthcare providers, financial counselors, clinical support staff, and hospital administration at participating clinical sites. Findings from this study will inform future large-scale, multi-site hybrid effectiveness-implementation research to assess the scalability of I-ACCESS across care delivery settings and its integration with ongoing care.