How Oncology Nurses Can Help Patients Overcome Financial Toxicity
No matter the diagnosis, patient age, treatment plan, or care team, there is one side effect that the majority of cancer patients will experience: financial toxicity. Even with health insurance and savings, patients face financial concerns as a result of treatment demands.
For more insight on the oncology nurse’s role in addressing this issue, we turned to Jean Sellers, MSN, RN, and Executive Director of North Carolina Oncology Navigator Association, an organization that advances the role of patient navigators through advocacy, evidence-based research, and the creation of best practices.
Sellers believes that much like talking to social workers, patients can and should lean on nurses as another trusted source of financial advice. For nurses, that means understanding this vital role and equipping themselves to have meaningful conversations about the cost of care.
Breaking the silence
“We know that upon hearing the words, ‘it’s malignant,’ patients will often struggle with two questions: ‘Am I going to die?’ and ‘How am I going to pay for this?’” Sellers said.
Despite this, patients often avoid talking about their financial concerns with their family or care team. Sellers worked with a patient in the past, for example, who underwent a bone marrow transplant and didn’t want to burden her family with the cost. She was eventually turned over to a collection agency for not paying the steep bill and confided in Sellers, admitting that the financial shame was almost as unbearable as the bone marrow transplant.
“Our patients are suffering in silence,” Sellers concludes. “We need to intervene early and quickly, letting them know that they are not alone and that there is help.”
Understanding the nurse’s role in reducing financial toxicity
Nurses have reputations of honesty and integrity in medical care, illustrated by an 18-year streak of earning the most-trusted profession title by Gallup’s annual poll on ethics and honesty. This puts them in an appropriate position to talk with their patients about the financial side of their treatment.
From newly diagnosed patients to those entering the post-treatment stage, Sellers suggests that nurses start with a simple question: “Are you concerned about the cost of your care?”
As these conversations develop, nurses can educate patients, encourage them to ask questions, reassure them that sharing financial concerns will not affect the level of treatment or care they receive, and, ultimately, provide comfort in knowing their care team is there to help.
Kate Yeager, PhD, RN, further argues that discussing financial health should be routine in clinical assessments. Like Sellers, Yeager says nurses can have a hand in promoting cost transparency, suggesting financial resources, and advocating for open and honest communication about the cost of care.
What’s more, there is growing evidence to suggest that financial toxicity affects treatment adherence, quality of life, and well-being. Oncology nurses can create safe spaces that allow patients to discuss their concerns about the cost of care before they become vulnerable to these additional consequences of financial toxicity.
Preparing for the conversations
Money isn’t always an easy subject to bring up, and nurses may not initially feel equipped to have helpful conversations with patients. However, even with an understanding of basic financial terms – including out-of-pocket costs, copays, co-insurance, deductibles, and cost sharing – and a go-to list of helpful resources, nurses can significantly shape a patient’s financial journey with cancer.
“Talking about finances requires the nurse to have a basic knowledge and understanding of the financial landscape as well as a willingness to meet their patient where they are on this journey,” Sellers explained.
To best address financial concerns with patients, nurses should also be able to identify patients who are at high risk for financial toxicity, such as those who don’t have health insurance, families with limited household income, and members of minority populations.
While Sellers and many medical professionals encourage nurses to initiate these conversations, we also can’t place all of the responsibility on their shoulders. They are not financial counselors, but they can guide patients in the right direction. Sellers also argues that cancer care teams can coach patients to be proactive about the cost of treatment.
“Patients, caregivers, and their families need to understand they have a voice and a right to understand the cost of cancer care and how it will affect their lives,” Sellers said. “They need to ask questions during appointments and take an active role in understanding the bills they receive.”
Financial toxicity is a real and potentially life-threatening side effect of cancer, yet the shame and embarrassment that accompanies it often leaves patients without the resources they need to overcome it. With help from oncology nurses, we can continue chipping away at the shame and take giant steps toward eradicating financial toxicity altogether.
Always walking the fine line between her right and left brain, Stevie brings her creative and strategic thinking to her role as Marketing Coordinator. Through writing and design, she amplifies Family Reach’s voice and puts financial toxicity in the spotlight.
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