Childhood cancer survivors are at increased risk for underinsurance and health insurance–related financial burden. Compared with their siblings, adult survivors of childhood cancer have significantly lower rates of health insurance coverage and more difficulties obtaining coverage (Park et al, 2005). Inadequate health care coverage is likely to have serious health and financial implications for this at-risk population; thus, interventions targeting health insurance literacy (HIL) are needed.
In order to improve the ability of cancer survivors to understand and use health insurance, Elyse Park, PhD, Giselle Perez, PhD and colleagues have developed and tested a four-session health insurance navigation tools (HINT) intervention designed to enhance health insurance literacy (HIL) among childhood cancer survivors. HINT is delivered synchronously by a patient navigator and provides a corresponding informational booklet.
In a randomized pilot trial with survivors participating in the Childhood Cancer Survivor Study, the research team compared HINT with enhanced usual care (EUC, including booklet), assessing the feasibility, acceptability, and preliminary efficacy of the HINT intervention.
The pilot study included 82 participants; 80.5% completed all four HINT sessions, and participants rated the HINT intervention as helpful, with a mean score of 8.9 (0-10). The HINT intervention significantly improved HIL, with a large effect size (0.94. P < .001).
- HINT is a virtually delivered intervention that provides tailored education and support to help survivors understand and navigate their health insurance coverage.
- Compared to enhanced usual care (information booklet only), those receiving the HINT intervention reported higher health insurance literacy, lower perceived financial burden, and increased healthcare utilization.
- This pilot study supports the feasibility and acceptability of delivering health insurance navigation interventions to this high-risk population.
This work highlights the importance of addressing health insurance literacy as a critical component of survivorship care for childhood cancer survivors, who face elevated risks of underinsurance and financial hardship due to their complex medical needs. The HINT program is the first intervention to show improvements in long-term survivors’ health insurance literacy and financial burden related to healthcare costs. Larger randomized studies are needed to assess the efficacy and sustainability of health insurance navigation intervention on health insurance literacy and financial burden.
Read More
Park ER, Kirchhoff AC, Donelan K, Perez GK, McDonald A, Bliss CC, Foor A, van Thiel Berghuijs KM, Waters AR, Durieux N, Leisenring W, Armstrong GT, Ponzani C, Lopez A, Vaca Lopez PL, Battaglia T, Galbraith AA, Kuhlthau KA. Health Insurance Navigation Tools Intervention: A Pilot Trial Within the Childhood Cancer Survivor Study. JCO Oncol Pract. 2024 Mar 12:OP2300680.
Park ER, Li FP, Liu Y, Emmons KM, Ablin A, Robison LL, Mertens AC; Childhood Cancer Survivor Study. Health insurance coverage in survivors of childhood cancer: the Childhood Cancer Survivor Study. J Clin Oncol. 2005 Dec 20;23(36):9187-97.
Elyse Park, PhD MPH is the Director of the Health Promotion and Resiliency Intervention Research Program and a Professor of Psychiatry & Medicine at Harvard Medical School. In addition, she directs behavioral research for the MGH Tobacco Research & Treatment Center, the Benson-Henry Institute for Mind Body Medicine, and the MGH Cancer Survivorship Program.
Giselle Perez, PhD is the Associate Director of the Adolescent and Young Adult Cancer Program at MGH, Director of the Adolescent and Young Adult Research and the Mind Body Program for Cancer Survivors, and an Assistant Professor of Psychology at Harvard Medical School. Her research focuses on the development of behavioral and mind-body interventions to promote stress management and overall physical and emotional health outcomes for patients throughout the cancer spectrum. Clinically, she specializes in working with adolescents and young adults with cancer.
