{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T17:39:41Z","timestamp":1792431581670,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U19CA291430\u20105631"],"award-info":[{"award-number":["U19CA291430\u20105631"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000048","name":"American Cancer Society","doi-asserted-by":"publisher","award":["130798\u2010RSGI\u201017\u2010018\u201001\u2010CPHPS"],"award-info":[{"award-number":["130798\u2010RSGI\u201017\u2010018\u201001\u2010CPHPS"]}],"id":[{"id":"10.13039\/100000048","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cancer\u2010related financial hardships are common and negatively impact cancer\u2010related outcomes. Supporting patient\u2010clinician cost discussions, financial navigation, and insurance literacy may help mitigate this distress. This qualitative study informed the adaptation of the \u201cImproving Cancer Patients\u2019 Insurance Choices\u201d (I Can PIC) tool into the \u201cCancer Affordability REsources\u201d (CARE) Tool by updating content, design, and implementation processes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients \u2265\u200918 years, diagnosed with lung, prostate, colorectal, or gynaecological cancer within 3 years, English\u2010speaking, and treated at specified urban or rural cancer centres were included. Healthcare personnel (HP) were employed at one of these cancer centres and worked with the specified cancer types. The Consolidated Framework for Implementation Research (CFIR) and the 5As of Access in Healthcare Framework guided the development of semi\u2010structured interview guides and codebook. Interviews were conducted virtually, transcribed professionally, coded, and analysed using rapid thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010two patients with cancer and 14 HP from urban and rural cancer centres participated (N\u2009=\u200936). We identified four themes. First, there was a mismatch of expectations around cost conversations. HP expressed concerns about potentially introducing financial\u2010related distress and did not know specific cost information, while patients emphasised the need for cost discussions with HP. One shared, \u201cI'm kind of\u2026 removed from the financial aspect, which is good \u2018cause then I can just focus on taking care of patients.\u201d In contrast, one patient said, \u201c\u2026It's not acceptable to just have your hands up and say I don't know\u2026 a patient needs to know.\u201d Second, preferences for timing of cost conversations varied, with a need for both immediate and subsequent conversations per patient readiness. One patient shared, \u201cI would have loved to speak with someone about the cost, but I was more concerned about my survival\u2026\u201d. Third, there were multiple usability considerations, including technological demands, health literacy, and the perceived relevance of the tool. Fourth, context\u2010specific delivery is critical to ensure access.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This user\u2010centred content, usability, and implementation focused adaptation of the CARE Tool incorporated perspectives from patients, HP, and end\u2010users. Next steps will evaluate the CARE Tool in a clinical trial, assessing financial hardships, self\u2010efficacy, health insurance literacy, and implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient and Public Contribution<\/jats:title>\n                    <jats:p>This research teams includes a patient advocate and our research question, design, data collection, and interpretation of results was presented for feedback to our community advisory board, made up of patient and public research partners. We recruited patients and healthcare personnel to participate in this study. We greatly appreciate the time, perspective, and experience that our patient and community research partners and participants have contributed to this study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70846","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:00:18Z","timestamp":1788181218000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adapting a Cancer Cost and Health Insurance Tool for Implementation: Rapid Qualitative Analysis"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7379-0678","authenticated-orcid":false,"given":"Ashley J.","family":"Housten","sequence":"first","affiliation":[{"name":"Division of Public Health Sciences Washington University School of Medicine St. Louis MO USA"},{"name":"Program in Occupational Therapy Washington University in St. Louis St. Louis MO 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Vonder","family":"Haar","sequence":"additional","affiliation":[{"name":"Bursky School of Public Health, Washington University in St. Louis St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4829-4106","authenticated-orcid":false,"given":"Sophia","family":"Larson","sequence":"additional","affiliation":[{"name":"Program in Occupational Therapy Washington University in St. Louis St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5872-9556","authenticated-orcid":false,"given":"Su\u2010Hsin","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences Washington University School of Medicine St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Irvin","sequence":"additional","affiliation":[{"name":"BJC HealthCare St. Louis MO 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