Neoplasms

Skin and Connective Tissue Diseases

All Conditions

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Behaviors and Mental Disorders

Breast Neoplasms

Prostatic Neoplasms

Financial Stress

Stress, Psychological

Behavioral Symptoms

The patient will be asked to arrive 30 minutes early to their next scheduled appointment with their oncologist so they can complete a survey.

The patient will be video recorded at their appointment. The oncologist has agreed to be video recorded. Immediately after this appointment, the patient will be asked to complete another brief survey that takes about 20 minutes. The questions will ask about how the meeting went. The patient's meeting with the oncologist will not be delayed or changed in any way because of this study.

The patient will be asked to arrive 30 minutes early to their next scheduled appointment with their oncologist so they can complete a survey.

The patient will be shown an iPad with an "app" while waiting to see their oncologist. The app includes a short video and asks questions about the patient's financial concerns. The app will give the patient a list of questions the patient may want to ask their oncologist during their appointment. The patient will then meet with their oncologist. The meeting with the patient's oncologist will be video recorded. The oncologist has agreed to be video recorded. Immediately after meeting the oncologist, the patient will complete another brief survey. The questions will ask about how the meeting went and what the patient thought of the app. The meeting with the oncologist will not be delayed or changed in any way because of this study.

The patient will be asked to arrive 30 minutes early to their next scheduled appointment with their oncologist so they can complete a survey.

The patient will be shown an iPad with an "app" while waiting to see your oncologist. The app includes a short video and asks questions about your financial concerns. The app will give the patient a list of questions they may want to ask their oncologist during their appointment. The patient will then meet with their oncologist. The meeting with their oncologist will be video recorded. The oncologist has agreed to be video recorded. Immediately after meeting their oncologist, they will complete another brief survey. The questions will ask about how the meeting went and what they thought of the app. The patient's meeting with the oncologist will not be delayed or changed in any way because of this study. Two months after that appointment, the patient will be sent a reminder of the information that was presented on the app.

Patients will receive an individually-tailorable cancer treatment cost education and communication intervention delivered on an iPad just prior to meeting with their oncologist.

Group 2: The DISCO App

Patients randomized to this arm will receive usual care.

Group 1: Usual Care

Patients will receive an individually-tailorable cancer treatment cost education and communication intervention delivered on an iPad just prior to meeting with their oncologist. Then, 2 months later they will receive an intervention booster in the form of an individually-tailored email to remind patients of the contents of the intervention.

Group 3: The DISCO App + Booster

Lauren Hamel, PhD

Susan Eggly, PhD

Seongho Kim, PhD

Elisabeth Heath, M.D.

The DISCO App is designed to improve, during the interaction, patient active participation and patient-initiated oncologist treatment cost discussions, and, in the short term, patient's treatment cost knowledge, self-efficacy for managing both cost and physician interactions, referrals, perceived financial toxicity (i.e., distress and material hardship); in turn, these will affect longer-term outcomes of financial toxicity and adherence.

This work is based on the core scientific premise - that increasing patient active participation and the frequency and quality of treatment cost discussions will decrease the short- and longer-term burdens of financial toxicity through their influence on self-efficacy for managing treatment cost. The focus is on patient self-efficacy for managing treatment cost because it is expected that improved treatment cost education and patient-oncologist treatment cost discussions prompted by the DISCO App will directly improve the self-efficacy needed for patients to proactively manage treatment costs, thus reducing the material and psychological burden of financial toxicity. The DISCO App is not designed to increase patients' ability to pay or reduce the cost of treatment, but it may benefit patients by increasing: their knowledge of treatment costs, their self-efficacy for managing cost, and the likelihood they receive financial and psychological assistance and support. This research is significant because, if successful, reducing the material and psychological burden of financial toxicity will improve the quality of care and work toward achieving health equity. The DISCO App has already been tested for its feasibility and acceptability. The DISCO App will now be tested for its effectiveness in a diverse population of people with solid tumors treated with IV and oral chemotherapies.

The research tests the effectiveness of an application-based ("app") communication intervention designed to improve the frequency and quality of patient-oncologist treatment cost discussions during clinical interactions, and associated measures.

DISCO: A Patient Intervention to Reduce the Financial Burden of Cancer

Patient perceptions of the intervention's usefulness using an original scale.

An example item from the original measure: The DISCO App helped me ask my doctor my cost questions. Minimum = 1; Maximum = 5; higher is a better outcome.

Patient perceptions of the intervention booster's usefulness

If the interaction is visible in the video-recorded patient-physician interaction

How efficacious patients feel about communicating with physicians. Scale title: Self-efficacy in patient-physician interactions. Minimum = 1; Maximum = 5; higher is a better outcome.

How efficacious patients feel about managing their treatment costs. Scale title: Self-efficacy in managing treatment costs. Minimum = 1; Maximum = 5; higher is a better outcome.

If patients know the types of cost associated with cancer treatment

Anticipated financial harm due to treatment cost. Scale title: Adapted Comprehensive score for financial toxicity (COST) measure. Minimum = 0; Maximum = 4; lower is a better outcome.

Patient perception that treatment cost discussed with the physician

Scale title: Satisfaction with any treatment cost discussed with the physician that occurred. Minimum = 1; Maximum = 5; higher is a better outcome.

Observation of the frequency of a cost discussion. Minimum = 0; Maximum = undefined.

Observation of the quality of patient-physician communication.

If the patient was referred to a social worker or financial navigator. The number of patients who receive a referral to a social worker or a financial navigator.

How efficacious patients feel about managing their treatment costs. Scale title: Self-efficacy in managing treatment costs. Minimum = 1; Maximum = 5; higher is a better outcome.

An example item from the adapted scale: I am confident I can pay for the direct costs of my treatment.

Data will be aggregated using means and standard deviations.

The experience of financial harm due to treatment cost. Rate of patients who indicate they are experiencing financial burden due to cancer treatment costs.

If the patient followed up with social work/financial navigator if referred.

Data will be aggregated using frequency counts.

If the patient adhered to the recommended treatment

If the patient was unable to adhere to treatment due to cost

If the patient adhered to clinical appointments

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
DISCO: A Patient Intervention to Reduce the Financial Burden of Cancer	NCT04766190	Financial Toxic... Cancer Question Prompt... Breast Cancer Prostate Cancer	Group 2: The DI... Group 1: Usual ... Group 3: The DI...	18 Years -	Barbara Ann Karmanos Cancer Institute
DISCO: A Patient Intervention to Reduce the Financial Burden of Cancer	NCT04766190	Financial Toxic... Cancer Question Prompt... Breast Cancer Prostate Cancer	Group 2: The DI... Group 1: Usual ... Group 3: The DI...	18 Years -	Barbara Ann Karmanos Cancer Institute

Spots Global Cancer Trial Database for group 1: usual care