Yu-Ning Wong1, Mark D Schluchter2, Terrance L Albrecht2, Al Bowen Benson2, Joanne Buzaglo2, Michael Collins2, Anne Lederman Flamm2, Linda Fleisher2, Michael Katz2, Tyler G Kinzy2, Tasnuva M Liu2, Sharon Manne2, Seunghee Margevicius2, Dawn M Miller2, Suzanne M Miller2, David Poole2, Stephanie Raivitch2, Nancy Roach2, Eric Ross2, Neal J Meropol2. 1. Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA. yu-ning.wong@fccc.edu. 2. Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA.
Abstract
PURPOSE: The decision to enroll in a clinical trial is complex given the uncertain risks and benefits of new approaches. Many patients also have financial concerns. We sought to characterize the association between financial concerns and the quality of decision making about clinical trials. METHODS: We conducted a secondary data analysis of a randomized trial of a Web-based educational tool (Preparatory Education About Clinical Trials) designed to improve the preparation of patients with cancer for making decisions about clinical trial enrollment. Patients completed a baseline questionnaire that included three questions related to financial concerns (five-point Likert scales): "How much of a burden on you is the cost of your medical care?," "I'm afraid that my health insurance won't pay for a clinical trial," and "I'm worried that I wouldn't be able to afford the costs of treatment on a clinical trial." Results were summed, with higher scores indicating greater concerns. We used multiple linear regressions to measure the association between concerns and self-reported measures of self-efficacy, preparation for decision making, distress, and decisional conflict in separate models, controlling for sociodemographic characteristics. RESULTS:One thousand two hundred eleven patients completed at least one financial concern question. Of these, 27% were 65 years or older, 58% were female, and 24% had a high school education or less. Greater financial concern was associated with lower self-efficacy and preparation for decision making, as well as with greater decisional conflict and distress, even after adjustment for age, race, sex, education, employment, and hospital location (P < .001 for all models). CONCLUSION: Financial concerns are associated with several psychological constructs that may negatively influence decision quality regarding clinical trials. Greater attention to patients' financial needs and concerns may reduce distress and improve patient decision making.
RCT Entities:
PURPOSE: The decision to enroll in a clinical trial is complex given the uncertain risks and benefits of new approaches. Many patients also have financial concerns. We sought to characterize the association between financial concerns and the quality of decision making about clinical trials. METHODS: We conducted a secondary data analysis of a randomized trial of a Web-based educational tool (Preparatory Education About Clinical Trials) designed to improve the preparation of patients with cancer for making decisions about clinical trial enrollment. Patients completed a baseline questionnaire that included three questions related to financial concerns (five-point Likert scales): "How much of a burden on you is the cost of your medical care?," "I'm afraid that my health insurance won't pay for a clinical trial," and "I'm worried that I wouldn't be able to afford the costs of treatment on a clinical trial." Results were summed, with higher scores indicating greater concerns. We used multiple linear regressions to measure the association between concerns and self-reported measures of self-efficacy, preparation for decision making, distress, and decisional conflict in separate models, controlling for sociodemographic characteristics. RESULTS: One thousand two hundred eleven patients completed at least one financial concern question. Of these, 27% were 65 years or older, 58% were female, and 24% had a high school education or less. Greater financial concern was associated with lower self-efficacy and preparation for decision making, as well as with greater decisional conflict and distress, even after adjustment for age, race, sex, education, employment, and hospital location (P < .001 for all models). CONCLUSION: Financial concerns are associated with several psychological constructs that may negatively influence decision quality regarding clinical trials. Greater attention to patients' financial needs and concerns may reduce distress and improve patient decision making.
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