Implementing Financial Screening for Adolescents and Young Adults Treated in the Outpatient Oncology Setting.

Abstract

Adolescents and young adults (AYAs) with cancer are susceptible to financial hardship during and after a cancer diagnosis. Implementing systematic financial screening is essential to effectively addressing financial hardship. In this study, we evaluated the implementation of a financial screening process in outpatient oncology clinics treating AYAs at an urban academic cancer center. We evaluated the implementation of financial screening through direct-to-patient prompts via the electronic health record (EHR) patient portal using an implementation science framework. Evaluation metrics included screening response rates (reach, adoption), prevalence of financial hardship (effectiveness), and comparisons of AYA patients age 15-39 years by clinical and sociodemographic factors (implementation). Patient and caregiver interviews offered contextual insights for future scaling. From November 2022 to July 2024, 567 AYAs received cancer care across the clinics. Of them, 50% (N = 286) responded to screening via the portal, 15% declined, and 34% were not screened because of lack of engagement with the portal. Higher response rates were associated with identifying as women (55%), non-Hispanic White (55%), Asian (77%), Hispanic (54%), or preferring English (53%). Among respondents, 74% (n = 212) screened positive for financial hardship, with men (83%), non-Hispanic Black (76%), Hispanic (95%), Asian (82%), or Spanish-speaking (96%) AYAs more likely to screen positive. Interviews with 24 participants, including caregivers and Spanish speakers, revealed general comfort with the portal-based screening, although some preferred in-person conversations. Participants expressed interest in how the data would be used and if it would prompt follow-up support. Leveraging technology, such as through the EHR patient portal, facilitates the implementation of financial screening. However, it is likely most effective when combined with clinical team collaboration and multimodal screening approaches to enhance access and engagement.