H1 Acceptability of a Health Insurance Navigation Program to Assist Childhood Cancer Survivors: A Report From the Childhood Cancer Survivor Study
Allyson Foor, BA1; Giselle K. Perez, PhD1; Cayley C. Bliss, BA1; Calli O. Mitchell, MPH1; Anne C. Kirchhoff, PhD, MPH2; Karen A. Kuhlthau, PhD1; Aaron McDonald, PhD3; Karen Donelan, ScD1; Karely van Thiel Berghuijs, MS2; Austin Waters, MSPH2; Wendy Leisenring, ScD4; Gregory T. Armstrong, MD3; Elyse R. Park, PhD, MPH1
1Massachusetts General Hospital, Boston, MA; 2Huntsman Cancer Institute, Salt Lake City, UT; 3St. Jude Children’s Research Hospital, Memphis, TN; 4Fred Hutchinson Cancer Research Center, Seattle, WA
Background: Childhood cancer survivors often face late effects requiring more frequent, ongoing medical care. Understanding their health insurance is vital. Working with a patient navigator may help survivors better access long-term follow-up care; yet, there is a lack of navigation programs to support survivors in understanding health insurance.
Objective: To explore the acceptability of a virtual health insurance navigation program, Health Insurance Navigation Tools (HINT), for adult survivors of childhood cancer.
Methods: Childhood survivors from the Childhood Cancer Survivor Study were recruited from August 2020 to May 2021 (N=82; 53.7% female; 82.0% White, 7.0% Hispanic, 7.0% Black). Participants were randomized to receive a health insurance information booklet and 4 live Zoom sessions with a health insurance patient navigator (intervention) or a booklet alone (enhanced usual care). Electronic surveys were collected at baseline and 5-month follow-up; we report posttreatment survey data measuring satisfaction with navigation services, the educational booklet, and overall program quality (5-point Likert scale; 1=very poor to 5=excellent). We also assessed how well the program met their needs for insurance information (rated 1-10; 1=least helpful program you could imagine to 10=most helpful program you could imagine). Qualitative postintervention interviews with a subset of participants (n=24; 58.5% participation rate) further queried program acceptability. Three coders used rapid qualitative analysis to identify themes, then met to discuss discrepancies to achieve inter-rater reliability.
Results: Of the 41 survivors randomized to the intervention arm, 40 (98%) completed the follow-up survey. A majority of these participants reported satisfaction with the program. Most (82.9%) rated their communication with the navigator as “excellent.” Scheduling convenience (77.1%), the Zoom video conferencing format (77.1%), length of sessions (68.6%), visuals (68.6%), and the booklet (60.0%) were identified as “excellent.” Findings from exit interviews further support the acceptability of the HINT intervention. More than half of those interviewed conveyed how informative, helpful, and beneficial this program had been and endorsed the utility of having a health insurance expert guide them through resources and solutions they otherwise may not have known about. Most participants valued the live, virtual delivery of the program, particularly because they were able to connect with the patient navigator on a personal level. This reportedly helped them speak more openly about sensitive topics.
Conclusion: Findings confirm the acceptability of a virtually delivered HINT program. Overall, participants endorsed the convenience, utility, and personalized approach of HINT. The synchronous modality may offer a promising methodology for optimizing survivors’ understanding and use of their health insurance, which can have downstream effects on their long-term health.
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