The financial burden of unexpected hospitalizations for childhood cancer patients and their families.

267 Background: Complications of therapy, such as infection, pain, or dehydration, may cause financial stress for childhood cancer patients due to unexpected hospitalizations. Treatment for childhood cancer is typically provided at tertiary health care centers, requiring rural patients to travel long distances for care. We evaluated the perceived financial burden of unanticipated hospitalizations, insurance, and rurality on childhood cancer patients and their families. Methods: A single-site, cross-sectional survey of primary caretakers of childhood cancer patients was performed from July 2010-July 2012. Eligible patients were treated at a pediatric cancer hospital, diagnosed age ≤21 years and were ≤5 years from diagnosis (N=310). Financial burden was rated on a visual analog scale of 0-100. Multivariable linear regression models were used to calculate coefficients and 95% Confidence Intervals (CI) of financial burden by number of unexpected hospitalizations (0, 1-4, ≥5) and time since diagnosis. Results: The average age at diagnosis was 7.0 (SD 5.6) years. The most common diagnosis was leukemia (47.4%). The mean number of unexpected hospitalizations was 4.2 (SD 7.3). Patients did not differ on number of unexpected hospitalizations by current age, gender, race/ethnicity, or household income. In multivariable analyses, patients 1-5 years past diagnosis with ≥5 unexpected hospitalizations reported financial burden was 22.6 (95% CI 6.2-39.1, p=0.007) points higher than those with no hospitalization and 13.7 (95% CI 2.8-23.6 p=0.007) points higher than those with 1-4 hospitalizations. Patients <1 year from diagnosis did not differ. While type of insurance (public vs. private) did not impact burden, rural patients reported 15.0 (95% CI 6.8-23.2, p<0.001) points higher financial burden than urban patients. Conclusions: A high number of unexpected hospitalizations and rural residence were associated with greater financial burden for families of childhood cancer patients. Efforts to reduce unexpected admissions by managing side effects in outpatient visits, utilizing home health nurses and collaborating with local primary care physicians for remote patients could help ease the financial burden.

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Prepared and highly committed despite the risk of COVID-19 infection: a cross-sectional survey of primary care physicians’ concerns and coping strategies in Singapore

BMC Family Practice ◽

10.1186/s12875-021-01370-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jerrald Lau ◽

David Hsien-Yung Tan ◽

Gretel Jianlin Wong ◽

Yii-Jen Lew ◽

Ying-Xian Chua ◽

...

Keyword(s):

Primary Care ◽

Coping Strategies ◽

Stress Management ◽

Primary Care Physicians ◽

Well Being ◽

Pandemic Preparedness ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Accessible Information ◽

And Coping

Abstract Background Primary care physicians (PCPs) are first points-of-contact between suspected cases and the healthcare system in the current COVID-19 pandemic. This study examines PCPs’ concerns, impact on personal lives and work, and level of pandemic preparedness in the context of COVID-19 in Singapore. We also examine factors and coping strategies that PCPs have used to manage stress during the outbreak. Methods Two hundred and sixteen PCPs actively practicing in either a public or private clinic were cluster sampled via email invitation from three primary care organizations in Singapore from 6th to 29th March 2020. Participants completed a cross-sectional online questionnaire consisting of items on work- and non-work-related concerns, impact on personal and work life, perceived pandemic preparedness, stress-reduction factors, and personal coping strategies related to COVID-19. Results A total of 158 questionnaires were usable for analyses. PCPs perceived themselves to be at high risk of COVID-19 infection (89.9%), and a source of risk (74.7%) and concern (71.5%) to loved ones. PCPs reported acceptance of these risks (91.1%) and the need to care for COVID-19 patients (85.4%). Overall perceived pandemic preparedness was extremely high (75.9 to 89.9%). PCPs prioritized availability of personal protective equipment, strict infection prevention guidelines, accessible information about COVID-19, and well-being of their colleagues and family as the most effective stress management factors. Conclusions PCPs continue to serve willingly on the frontlines of this pandemic despite the high perception of risk to themselves and loved ones. Healthcare organizations should continue to support PCPs by managing both their psychosocial (e.g. stress management) and professional (e.g. pandemic preparedness) needs.

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Out-of-Pocket Costs and Perceived Financial Burden Associated with Prostate Cancer Treatment in a Quebec Remote Area: A Cross-Sectional Study

Current Oncology ◽

10.3390/curroncol28010005 ◽

2020 ◽

Vol 28 (1) ◽

pp. 26-39

Author(s):

Abir El-Haouly ◽

Anais Lacasse ◽

Hares El-Rami ◽

Frederic Liandier ◽

Alice Dragomir

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Financial Burden ◽

Cross Sectional Study ◽

University Education ◽

School Level ◽

Sectional Study ◽

Cross Sectional ◽

Perceived Burden ◽

Out Of Pocket Costs

Background: In publicly funded healthcare systems, patients do not pay for medical visits but can experience costs stemming from travel or over-the-counter drugs. We lack information about the extent of this burden in Canadian remote regions. This study aimed to: (1) describe prostate cancer-related out-of-pocket costs and perceived financial burden, and (2) identify factors associated with such a perceived burden among prostate cancer patients living in a remote region of the province of Quebec (Canada). Methods: A cross-sectional study was conducted among 171 prostate cancer patients who consulted at the outpatient clinic of the Centre Hospitalier de Rouyn-Noranda. Results: The majority of patients (83%) had incurred out-of-pocket costs for their cancer care. The mean total cost incurred in the last three months was $517 and 22.3% reported a moderate, considerable or unsustainable burden. Multivariable analysis revealed that having incurred higher cancer-related out-of-pocket costs (OR: 1.001; 95%CI: 1.001–1.002) private drug insurance (vs. public, OR: 5.23; 95%CI: 1.13–24.17) was associated with a greater perceived financial burden. Having better physical health-related quality of life (OR: 0.95; 95%CI: 0.913–0.997), a university education (vs. elementary/high school level, OR: 0.03; 95%CI: 0.00–0.79), and an income between $40,000 and $79,999 (vs. ≤ $39,999, OR: 0.15; 95%CI: 0.03–0.69) were associated with a lower perceived burden. Conclusion: Prostate cancer patients incur out-of-pocket costs even if they were diagnosed many years ago and the perceived burden is significant. Greater attention should be paid to the development of services to help patients manage this burden.

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Do primary care physicians’ own AUDIT scores predict their use of brief alcohol intervention? A cross-sectional survey

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2005.11.010 ◽

2006 ◽

Vol 83 (2) ◽

pp. 169-173 ◽

Cited By ~ 10

Author(s):

Mauri Aalto ◽

Senja Hyvönen ◽

Kaija Seppä

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Alcohol Intervention ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Brief Alcohol Intervention

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Prescribing Empiric Antibiotics for Febrile Neutropenia: Compliance with Institutional Febrile Neutropenia Guidelines

Pharmacy ◽

10.3390/pharmacy6030083 ◽

2018 ◽

Vol 6 (3) ◽

pp. 83 ◽

Cited By ~ 3

Author(s):

Doaa Naeem ◽

Majed Alshamrani ◽

Mohammed Aseeri ◽

Mansoor Khan

Keyword(s):

Febrile Neutropenia ◽

Cancer Patients ◽

Bacterial Infections ◽

Cross Sectional Study ◽

Cross Sectional ◽

Management Guidelines ◽

Empiric Antibiotics ◽

Inappropriate Use ◽

Common Diagnosis ◽

The Mean

Background: Febrile neutropenia (FN) is an oncologic emergency which should be treated immediately with empiric antibiotics. Different institutions observe different antibiograms and use different FN management guidelines. Our center implemented FN management guidelines for adult cancer patients in 2009. Hence, we decided to assess compliance with FN management guidelines and to describe the pattern of bacterial infections. Method: We conducted a cross-sectional study on all adult cancer patients admitted with FN. Data were collected from electronic medical records between January and December 2014. Results: One hundred FN episodes met the study inclusion criteria. The mean age of the patients was 41 ± 17 years; 52% (52 patients) were women. The most common diagnosis was lymphoma (33%). In terms of compliance to institutional FN guidelines, 55% of patients received guideline non-compliant treatment. The most common non-compliant treatment was incorrect amikacin dosing in 31% of patients, followed by incorrect vancomycin dosing in 20%, incorrect piperacillin/tazobactam dosing in 19%, inappropriate use of carbapenems in 18%, and non-compliant vancomycin use in 12% of patients. Bacterial isolates were only observed in 19% of the FN episodes. Among these 19 episodes of FN, Gram-negative pathogens were predominant and were identified in 74% of the episodes, followed by Gram-positive pathogens in 16% and polymicrobial pathogens in 10%. The mean time to defervescence was 2.21 ± 2 days. Conclusion: Our study concluded that there was a high percentage of non-compliance with our institutional FN management guidelines. We recommend following appropriate empiric antibiotic doses and indications as per institutional guidelines.

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The impact of an ostomy on older colorectal cancer patients: a cross-sectional survey

International Journal of Colorectal Disease ◽

10.1007/s00384-016-2665-8 ◽

2016 ◽

Vol 32 (1) ◽

pp. 89-94 ◽

Cited By ~ 13

Author(s):

N. M. Verweij ◽

M. E. Hamaker ◽

D. D. E. Zimmerman ◽

Y. T. van Loon ◽

F. van den Bos ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Colorectal Cancer Patients ◽

The Impact

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Stockpiled personal protective equipment and knowledge of pandemic plans as predictors of perceived pandemic preparedness among German general practitioners

PLoS ONE ◽

10.1371/journal.pone.0255986 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255986

Author(s):

Arno Stöcker ◽

Ibrahim Demirer ◽

Sophie Gunkel ◽

Jan Hoffmann ◽

Laura Mause ◽

...

Keyword(s):

General Practitioners ◽

Personal Protective Equipment ◽

Explanatory Power ◽

Vital Role ◽

Protective Equipment ◽

Linear Regression Models ◽

Pandemic Preparedness ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Determining Factor

Background The COVID-19 pandemic significantly changed the work of general practitioners (GPs). At the onset of the pandemic in March 2020, German outpatient practices had to adapt quickly. Pandemic preparedness (PP) of GPs may play a vital role in their management of a pandemic. Objectives The study aimed to examine the association in the stock of seven personal protective equipment (PPE) items and knowledge of pandemic plans on perceived PP among GPs. Methods Three multivariable linear regression models were developed based on an online cross-sectional survey for the period March–April 2020 (the onset of the pandemic in Germany). Data were collected using self-developed items on self-assessed PP and knowledge of a pandemic plan and its utility. The stock of seven PPE items was queried. For PPE items, three different PPE scores were compared. Control variables for all models were gender and age. Results In total, 508 GPs were included in the study; 65.16% believed that they were very poorly or poorly prepared. Furthermore, 13.83% of GPs were aware of a pandemic plan; 40% rated those plans as beneficial. The stock of FFP-2/3 masks, protective suits, face shields, safety glasses, and medical face masks were mostly considered completely insufficient or insufficient, whereas disposable gloves and disinfectants were considered sufficient or completely sufficient. The stock of PPE was significantly positively associated with PP and had the largest effect on PP; the association of the knowledge of a pandemic plan was significant but small. PPE scores did not vary considerably in their explanatory power. The assessment of a pandemic plan as beneficial did not significantly affect PP. Conclusion The stock of PPE seems to be the determining factor for PP among German GPs; for COVID-19, sufficient masks are the determining factor. Knowledge of a pandemic plans play a secondary role in PP.

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Out-of-Pocket Spending for Cancer Medication, Financial Burden, and Cost Communication with Oncologists in the Last Six Months of Life in Israel

Healthcare ◽

10.3390/healthcare9091120 ◽

2021 ◽

Vol 9 (9) ◽

pp. 1120

Author(s):

Aviad Tur-Sinai ◽

Netta Bentur ◽

Damien Urban

Keyword(s):

Private Health Insurance ◽

Financial Burden ◽

Female Gender ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Complex Interactions ◽

The Cost ◽

Treatment Alternatives ◽

Financial Burden Of Cancer ◽

Heavy Financial Burden

Honest communication between oncologists and patients is important in alleviating the financial burden of cancer care. This study explored patient–relative–oncologist communication regarding the affordability of out-of-pocket (OOP) medication and the extent to which this communication addresses itself to the families’ financial burden. A cross-sectional survey was conducted among primary caregivers of deceased cancer patients. About 43% of relatives said that they and/or the patients had paid out of pocket for medications during the last six months of the patient’s life. Most (73%) oncologists suggested an OOP medication without asking about financial ability, 43% hardly explained the advantages of an OOP medication, and 52% hardly explained any treatment alternatives. Older age and female gender were related to less communication about an OOP medication, and better education, greater affluence, and having private health insurance were related to more communication. About 56% of relatives said that OOP payment for medications inflicted a very heavy or heavy financial burden on patients and their households. Physicians’ interest in financial ability and giving explanation lightened the burden. Given the difficulty of explaining the complex interactions of cost and clinical outcomes, oncologists need to be better educated in skills that would enable them to communicate costs more openly and should consider the cost of a treatment when prescribing it.

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Paid parental leave and fathers’ involvement: capturing fathers’ gender beliefs and fathering perceptions

Families Relationships and Societies ◽

10.1332/204674320x16083746098965 ◽

2021 ◽

Author(s):

Luisa A. Streckenbach ◽

Laura Castiglioni ◽

Pia S. Schober

Keyword(s):

Self Efficacy ◽

Parental Leave ◽

Positive Association ◽

Linear Regression Models ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Paid Leave ◽

Indirect Care ◽

Paid Parental Leave ◽

Gender Traditionalism

This study examines how multidimensional gender and fathering beliefs of fathers may explain their relative involvement in childcare after considering paid leave uptake. We draw on cross-sectional survey data from one German state, which allow us to distinguish three belief dimensions: (1) gender traditionalism and essentialism, (2) fathering attitudes, and (3) fathering self-concepts and self-efficacy. By means of multiple linear regression models we investigate how the different dimensions of gender and fatherhood beliefs relate to fathers’ relative involvement in basic and indirect childcare tasks. Our results show that gender (essentialist) ideologies and fatherhood attitudes were strongly associated with fathers’ relative involvement in both childcare domains. The higher fathers perceived self-efficacy in fathering, the more involved they were in basic but not indirect care. All belief dimensions mediated the positive association of fathers’ uptake of paid leave with their involvement in basic childcare.

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Patients’ knowledge and awareness of safe handling of oral anticancer agents at Sultan Qaboos University Hospital in Oman

Journal of Oncology Pharmacy Practice ◽

10.1177/10781552211056238 ◽

2021 ◽

pp. 107815522110562

Author(s):

Moataz M Hassan ◽

Dhabya Al-Marzooq ◽

Hanan Al-Habsi ◽

Amna Al-Hashar ◽

Murtadha Al-Khabori ◽

...

Keyword(s):

Cancer Patients ◽

Anticancer Agents ◽

Oral Chemotherapy ◽

University Hospital ◽

National Guidelines ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Safe Handling ◽

Chemotherapy Drugs ◽

Oral Anticancer Agents

Background Safe handling of oral anticancer agents is of great concern. There is a lack of clear, national guidelines on how patients can safely handle and dispose of unwanted medications. We aimed to evaluate the safe handling, storage, and disposal of oral anticancer drugs among cancer patients and caregivers at home. Method This cross-sectional survey of adult cancer patients (or their adult caregivers) used a closed-ended questionnaire from May 2019 to March 2020. Results A total of 257 patients (50 ± 15 years; range: 18–93 years) were enrolled; however, only 91% (233/257) reported self-administering oral anticancer medications. Caregivers were more likely to administer oral anticancer agents for patients ≥60 years than those <40 years old (63% vs. 8%; P = 0.001). Most patients (52%; 133/257) did not wash their hands after administering the drug; 74% (164/222) of the respondents reported that their medications were kept in a bedroom cabinet, while 18% (40/222) stored their medications in a refrigerator, and 5% (12/222) in a kitchen cabinet. A total of 55% (68/124) of patients returned their excess oral chemotherapy medications to the hospitals; however, 36% (45/124) disposed of their unused oral chemotherapy drugs in a household garbage container. Conclusion While two-thirds of patients stored their oral anticancer medications properly, more than half used inappropriate handling procedures. Disposal practices were inconsistent and did not adhere to the reported international guidelines.

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