{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:25:32Z","timestamp":1790180732125,"version":"4.1.0"},"reference-count":37,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005972","name":"Deutsche Krebshilfe","doi-asserted-by":"publisher","award":["70113978"],"award-info":[{"award-number":["70113978"]}],"id":[{"id":"10.13039\/501100005972","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,1,10]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"\n Objectives<\/jats:title>\n Patient-reported financial effects of a tumour disease in a universal healthcare setting are a multidimensional phenomenon. Actual and anticipated objective financial burden caused by direct medical and non-medical costs as well as indirect costs such as loss of income can lead to subjective financial distress. To better understand subjective financial distress, the presented study explores self-reported determinants for subjective financial distress in German patients with cancer, aiming to inform a new German-language patient-reported outcome measure for determining the financial effects of a tumour disease.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Semistructured interviews with n=18 patients with cancer were conducted between May 2021 and December 2021. Patients were recruited based on a purposive sampling strategy in outpatient and inpatient settings. The interviews were audiorecorded, transcribed verbatim and analysed using qualitative content analysis.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Participants were recruited from two German academic cancer centres, that is, the National Center for Tumor Diseases Heidelberg and Jena University Hospital.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n 18 patients who had undergone cancer-related therapy for at least 2\u2009months were interviewed (10 females).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Based on the results of the qualitative content analysis, we developed a multicomponent construct of determinants that could influence subjective financial distress. The self-reported determinants can be classified into material (\n savings, good salary, shared rent through shared living, employed partner, paid-off house, potential financial support from family and friends, work-related specifics, consumer restrictions, out-of-pocket-costs and anticipated financial changes<\/jats:italic>\n ), social (\n social support from friends and family<\/jats:italic>\n ), systemic (\n administrative hurdlers and insurance cover<\/jats:italic>\n ) and inner personal determinants (\n coping strategies, change of attitude, character traits<\/jats:italic>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Subjective financial distress depends not only on material but also on social, systemic and inner personal determinants. Knowledge of these determinants can inform a new comprehensive German-language instrument for measuring self-reported financial effects of a tumour disease.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT05319925<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-081432","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:55:19Z","timestamp":1738112119000},"page":"e081432","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Self-reported determinants for subjective financial distress: a qualitative interview study with German cancer patients"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct05319925","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5540-780X","authenticated-orcid":false,"given":"Andrea","family":"Z\u00fcger","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Section Translational Medical Ethics, National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktoria","family":"Mathies","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Jena University Hospital, Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Mehlis","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Section Translational Medical Ethics, National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Pauge","sequence":"additional","affiliation":[{"name":"Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luise","family":"Richter","sequence":"additional","affiliation":[{"name":"Methods in Empirical Social Research, Institute of Sociology, Faculty of Arts, Humanities and Social Science, Dresden University of Technology, Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastian","family":"Surmann","sequence":"additional","affiliation":[{"name":"Department of Health Economics and Health Care Management, Faculty of Health Science, Bielefeld University, Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Ernst","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Jena University Hospital, Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalja","family":"Menold","sequence":"additional","affiliation":[{"name":"Methods in Empirical Social Research, Institute of Sociology, Faculty of Arts, Humanities and Social Science, Dresden University of Technology, Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Greiner","sequence":"additional","affiliation":[{"name":"Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Winkler","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Section Translational Medical Ethics, National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,28]]},"reference":[{"key":"2025121601135843000_15.1.e081432.1","first-page":"1131","article-title":"Coping mechanisms for financial toxicity: a qualitative study of cancer patients\u2019 experiences in Germany","volume":"28","author":"Schr\u00f6der","year":"2020","journal-title":"Support Care Cancer"},{"key":"2025121601135843000_15.1.e081432.2","first-page":"5753","article-title":"The financial coping strategies of US cancer patients and survivors","volume":"29","author":"Doherty","year":"2021","journal-title":"Support Care 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