Social Determinants of Health Research Project

Project Summary- Social Determinants of Health Multilevel Intervention Financial toxicity—hardships caused by the costs of cancer treatment—are common and have a substantial impact on cancer outcomes and patient wellbeing. The signature multi-level intervention trial of the Washington University Advancing Cancer Control Engaged Research through Transformative Solutions (WashU-ACCERT) Center aims to improve quality of life among patients diagnosed with cancer throughout their treatment and into survivorship by addressing access to and affordability of cancer care and the financial burden associated with cancer treatment costs. This is directly responsive to community-identified concerns around access to care and affordability. We will achieve this by adapting the existing web-based I CAN PIC to CARE Tool (Cancer Affordability Resources) tool and pairing it with clinician and organizational training to address cancer care costs. The patient-focused tool is designed to provide education on insurance, support people with cancer in making choices about health insurance, accessing resources to offset the financial burden of care, and building self-efficacy for discussing care costs with clinicians. Outcomes will be assessed at the patient, provider, and organizational levels. Aim 1 will engage end-users to adapt I CAN PIC to CARE Tool employing a user-centered approach. Aim 2 will prepare for multi-level implementation using the Expert Recommendations for Implementing Change (ERIC) strategies. Aim 3 will implement and evaluate the CARE Tool in a randomized trial. This project will adapt, implement, and evaluate the CARE Tool in urban and rural Missouri, reflecting the WashU- ACCERT Center theme on the interaction between people, their unique qualities, and geography (i.e., urban vs rural) and addressing access to health and healthcare as defined by the Center’s conceptual framework: affordability, availability, attainability, accommodation, acceptability. Our multidisciplinary research team, including university and community co-leads, comprises experts in patient-centered communication, implementation science, community engagement, and health economics. This project will advance our understanding of the impact of the affordability, availability, attainability, accommodation, and acceptability on adverse cancer outcomes. As part of the WashU-ACCERT Community Responsive Research Program, this adaptation, implementation, and evaluation of the CARE Tool addresses community-identified priorities around access to care and affordability. It will provide critical insights into advancing engagement by addressing the impact of affordability, availability, attainability, accommodation, and acceptability for all people and geographies (i.e., urban vs rural).