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Financial Toxicity in Cancer Care

Living in the US, we are faced with a healthcare system that is privatized and confusing, while often reliant on insurance companies to help us with the monetary aspects of our care. This position, however, can often leave individuals with unanswered questions, economic tradeoffs, and financial fragility.

 

Background

Memorial Sloan Kettering (MSK) is a premiere cancer hospital and research institution in the US. Within the hospital is a team called the Design Impact Group, which works to use Human Centered Design to aid the hospital in new services, strategies, and products focused around patients and staff.

MSK was interested in understanding the role of financial toxicity on their community. They paired our fellowship with the Immigrant Health and Cancer Disparities Service to begin to research into the impact that finances have on patients, before, during, and after treatment.

Team: Rhea Bhandari, Holly Cargill

Context: Graduate Design Fellowship @ Memorial Sloan Kettering

Role: Researcher

Timeline: June 2018 - Aug 2018

Focus: Design Research; Synthesis; User Journeys


 
Financial Toxicity: a term used to describe problems a patient has related to the cost of medical care. Not having health insurance or having a lot of costs for medical care not covered by health insurance can cause financial problems and may lead to debt and bankruptcy.
— National Cancer Institute
 

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Research Methods

I. Secondary Research

We started our research looking at scientific studies on finances in health and cancer care. We reinforced this information with studies on Z and related financial stressors, including student loans and bankruptcy.

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44% of subjects found talking about finances the hardest conversation to have, compared to 38% around death.

44% of subjects found talking about finances the hardest conversation to have, compared to 38% around death.

II. In Person Observation

Clinical Shadowing - The team collectively completed 7 clinical rotations with the breast, urology, and radiation oncology units, shadowing doctors as they worked with patients to convey their current physical situation, as well as discuss the range of topics surrounding it. Shadowing gave us insight into patient-doctor relationships, timing, and information shared during appointments.

Cancer Hospital Food Banks - Working with the Immigrant Health team, we observed multiple food banks across the city, including one at MSK, that caters to lower income cancer patients. This allowed us to gather information on demographics and the role food plays in cancer treatment.

III. Semi Structured Interviews

We conducted 31 interviews from a range of stakeholders, including patients, doctors, MSK financial staff, researchers, and patient advocates. We used a variety of tools to prompt deeper reflection, including card sorts and a timeline of their financial life in regards to treatment.

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IV. Co-Creation Workshops

We ran a multi-stakeholder workshops with the DIG team, caregivers, MSK staff, and patients, using two maps on services and everyday activities. Participants were asked to discuss, edit, and highlight key tension points through a co-creative process.

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Synthesis & Insights

After our research, we synthesized everything we had heard, pulling out key quotes and distilling patient timelines into an average journey map. From here, we identified our key insights, which you can read below.

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Photos of Our Journey