64 Background: Financial toxicity is an increasingly recognized problem for patients receiving cancer treatment, particularly in the high-cost precision medicine era. Financial toxicity is linked to asset depletion, debt, and bankruptcy. To address this imminent concern, we designed, implemented, and evaluated a fellow-initiated financial toxicity screening tool for use in medical oncology clinics. Methods: An interprofessional team of University of California San Francisco (UCSF) social workers and physicians selected three highly rated items from the COST measure, a published financial toxicity tool with validity evidence. We oriented all UCSF hematology/oncology fellows to the tool and the concept of financial toxicity. We instructed fellows to screen all patients other than second-opinion visits and to offer a social work referral to high-scoring patients. Implementation was from August 2017 to March 2018. While screening was initially documented in the progress note, in October 2017 we built a navigator into the electronic medical record to facilitate screening. We randomly selected one half-day per week for each fellow and reviewed charts for screening scores. The cumulative goal was to screen 30% of eligible patients during implementation. Results: Fellows (n = 8) rotated in five disease-specific medical oncology clinics. Prior to implementation, fellows did not document financial toxicity (0%). At the mid-point of implementation, fellows had screened 32% of patients. By the end, the cumulative screening rate decreased to 18%. The screening tool will be presented. Qualitative fellow feedback identified lack of provider familiarity with financial toxicity, packed clinic visits, and difficulty remembering to screen as barriers. Fellows suggested that screening performed by clinic staff prior to the encounter might better inform the visit. Conclusions: Fellow-initiated financial toxicity screening was initially successful but decreased over time. Future iterations could include screening prior to the encounter, augmenting provider financial toxicity training, and continual reminders. Future work is needed to improve screening and mitigate the impact of financial toxicity.
Development of a Financial Toxicity Screening Tool for Radiation Oncology: A Secondary Analysis of a Pilot Prospective Patient-Reported Outcomes Study
