{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T21:49:24Z","timestamp":1792619364323,"version":"4.5.0"},"reference-count":60,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T00:00:00Z","timestamp":1684108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008460","name":"National Center for Complementary and Integrative Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008460","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006085","name":"Office of Disease Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006085","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000179","name":"Office of the Director","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000179","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Cancer-related financial hardship is associated with negative clinical outcomes, which may be partially explained by cost-related delayed or forgone care in response to financial barriers. We sought to understand patient experiences facing financial barriers to medical care following a cancer diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted virtual, semi-structured interviews in Fall 2022 with 20 adults with a history of cancer who had experienced cancer-related financial hardship in the prior year. We used template analysis within a pragmatic paradigm, combining constructivist and critical realist theoretical perspectives, to analyze interview transcripts and adapt an existing conceptual framework of financial barriers to care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The majority of interviewees identified as women (70%), non-Hispanic white (60%), and reported an annual household income of &amp;lt;$48,000 (60%). As interviewees sought to overcome financial barriers, they described substantial frustration at the limitations and complexities of United States health and social care systems, resulting in a reliance on a fragmented, uncertain resource landscape. The administrative burden resulting from bureaucratic systems and the advocacy responsibilities required to navigate them ultimately fell on interviewees and their caregivers. Thus, participants described their ability to overcome financial barriers as being influenced by individual and interpersonal factors, such as social support, comfort asking for help, time, prior experience navigating resources, and physical and mental health. However, participants noted health system organizational factors, such as whether all new patients proactively met with a social worker or financial navigator, as having the potential to lessen the administrative and financial burden experienced.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We present an adapted conceptual framework outlining multi-level factors influencing patient experiences coping with financial barriers to medical care. In addition to influencing whether a patient ultimately delays or forgoes care due to cost, financial barriers also have the potential to independently affect patient mental, physical, and financial health.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyg.2023.1178517","type":"journal-article","created":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T04:50:32Z","timestamp":1684126232000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":22,"title":["Facing financial barriers to healthcare: patient-informed adaptation of a conceptual framework for adults with a history of cancer"],"prefix":"10.3389","volume":"14","author":[{"given":"Caitlin B.","family":"Biddell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin R.","family":"Waters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebekah S. M.","family":"Angove","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen D.","family":"Gallagher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald L.","family":"Rosenstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa P.","family":"Spees","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin E.","family":"Kent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arrianna Marie","family":"Planey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie B.","family":"Wheeler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,5,15]]},"reference":[{"key":"ref1","first-page":"435","article-title":"The association between insurance type and cost-related delay in care: a survey","volume":"23","author":"al Rowas","year":"2017","journal-title":"Am. J. Manag. Care"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"31","DOI":"10.3322\/caac.21586","article-title":"Understanding and addressing social determinants to advance cancer health equity in the United States: a blueprint for practice, research, and policy","volume":"70","author":"Alcaraz","year":"2020","journal-title":"CA Cancer J. Clin."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"djw205","DOI":"10.1093\/jnci\/djw205","article-title":"Financial hardships experienced by cancer survivors: a systematic review","volume":"109","author":"Altice","year":"2017","journal-title":"J. Natl. Cancer Inst."},{"key":"ref4","unstructured":"AminK\n            ClaxtonG\n            RamirezG\n            CoxC\n          2021"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.1002\/pon.2021","article-title":"The meaning of cancer: implications for family finances and consequent impact on lifestyle, activities, roles and relationships","volume":"21","author":"Amir","year":"2012","journal-title":"Psychooncology"},{"key":"ref6","volume-title":"Critical Realism: Essential Readings","author":"Archer","year":"1998"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1111\/j.1532-5415.2011.03481.x","article-title":"Effect of mental disorders on diagnosis, treatment, and survival of older adults with Colon Cancer","volume":"59","author":"Baillargeon","year":"2011","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e0176470","DOI":"10.1371\/journal.pone.0176470","article-title":"Financial distress in patients with advanced cancer","volume":"12","author":"Barbaret","year":"2017","journal-title":"PLoS One"},{"key":"ref9","article-title":"Equity-centered approaches to qualitative research","volume-title":"Qualitative Research Summer Intensive","author":"Black","year":"2022"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e5561","DOI":"10.1097\/MD.0000000000005561","article-title":"Finding resiliency in the face of financial barriers: development of a conceptual framework for people with cardiovascular-related chronic disease","volume":"95","author":"Campbell","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e533","DOI":"10.1200\/JOP.18.00112","article-title":"Going for broke: a longitudinal study of patient-reported financial sacrifice in Cancer care","volume":"14","author":"Chino","year":"2018","journal-title":"J. Oncol. Pract."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1177\/1363459307080876","article-title":"A critical realist approach to understanding and evaluating heart health programmes","volume":"11","author":"Clark","year":"2007","journal-title":"Health (London)"},{"key":"ref13","volume-title":"Dedoose Version 9.0.62, Web Application for Managing, Analyzing, and Presenting Qualitative and Mixed Method Research Data [Computer Program]","year":"2022"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/07347332.2022.2149374","article-title":"\u201cI wish I knew about these programs before!\u201d a brief report exploring barriers to financial assistance reported by gynecological oncology patients","volume":"14","author":"Doherty","year":"2022","journal-title":"J. Psychosoc. Oncol."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1778","DOI":"10.1158\/1055-9965.EPI-20-1853","article-title":"Evidence of the feasibility and preliminary efficacy of oncology financial navigation: a scoping review","volume":"30","author":"Doherty","year":"2021","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.1093\/aje\/kwaa146","article-title":"Financial strain and suicide attempts in a nationally representative sample of US adults","volume":"189","author":"Elbogen","year":"2020","journal-title":"Am. J. Epidemiol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s00520-022-07472-x","article-title":"The least costly pharmacy for cancer supportive care medications over time: the logistic toxicity of playing catch up","volume":"31","author":"Etteldorf","year":"2022","journal-title":"Support Care Cancer"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1037\/ort0000030","article-title":"The health equity promotion model: reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities","volume":"84","author":"Fredriksen-Goldsen","year":"2014","journal-title":"Am. J. Orthopsychiatry"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2735","DOI":"10.3390\/curroncol29040223","article-title":"The economic burden of Cancer in Canada from a societal perspective","volume":"29","author":"Garaszczuk","year":"2022","journal-title":"Curr. Oncol."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1200\/JCO.2010.28.4455","article-title":"Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis","volume":"29","author":"Giese-Davis","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.2217\/fon-2021-1282","article-title":"Financial toxicity and its impact on health outcomes and caregiver burden among adult cancer survivors in the USA","volume":"18","author":"Inguva","year":"2022","journal-title":"Future Oncol."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/07347332.2022.2142877","article-title":"Prevalence and risk factors of self-reported financial toxicity in cancer survivors: a systematic review and meta-analyses","author":"Jiang","year":"2022","journal-title":"J. Psychosoc. Oncol."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"3095","DOI":"10.2217\/fon-2020-0547","article-title":"A theoretical model of financial burden after cancer diagnosis","volume":"16","author":"Jones","year":"2020","journal-title":"Future Oncol."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1002\/pon.4677","article-title":"Financial difficulty, worry about affording care, and benefit finding in long-term survivors of cancer","volume":"27","author":"Jones","year":"2018","journal-title":"Psychooncology"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"8905","DOI":"10.1007\/s00520-022-07234-9","article-title":"Shared burden: the association between cancer diagnosis, financial toxicity, and healthcare cost-related coping mechanisms by family members of non-elderly patients in the USA","volume":"30","author":"Kazzi","year":"2022","journal-title":"Support Care Cancer"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e2223141","DOI":"10.1001\/jamanetworkopen.2022.23141","article-title":"Association of Health Insurance Literacy with Financial Hardship in patients with Cancer","volume":"5","author":"Khera","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref27","unstructured":"KingN\n            BrooksJM\n          2017"},{"key":"ref28","volume-title":"The SAGE Handbook of Qualitative Business and Management Research Methods: Methods and Challenges. Chapter 14: Thematic Analysis in Organisational Research","author":"King","year":"2018"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e665","DOI":"10.1200\/JOP.18.00120","article-title":"Financial toxicity in adults with Cancer: adverse outcomes and noncompliance","volume":"14","author":"Knight","year":"2018","journal-title":"J. Oncol. Pract."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/1475-9276-12-18","article-title":"Patient-centred access to health care: conceptualising access at the interface of health systems and populations","volume":"12","author":"Levesque","year":"2013","journal-title":"Int. J. Equity Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2273","DOI":"10.1007\/s00520-021-06643-6","article-title":"Identifying missing links in the conceptualization of financial toxicity: a qualitative study","volume":"30","author":"Lueckmann","year":"2022","journal-title":"Support Care Cancer"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e1856","DOI":"10.1200\/OP.20.01009","article-title":"Sensitivity of psychosocial distress screening to identify Cancer patients at risk for financial hardship during care delivery","volume":"17","author":"Maldonado","year":"2021","journal-title":"JCO Oncol Pract."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample size in qualitative interview studies: guided by information power","volume":"26","author":"Malterud","year":"2016","journal-title":"Qual. Health Res."},{"key":"ref34","volume-title":"Qualitative Data Analysis: A Methods Sourcebook","author":"Miles","year":"2015"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.1111\/cobi.12326","article-title":"A guide to understanding social science research for natural scientists","volume":"28","author":"Moon","year":"2014","journal-title":"Conserv. Biol."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e517","DOI":"10.1016\/S1470-2045(20)30623-9","article-title":"Declines in health insurance among cancer survivors since the 2016 US elections","volume":"21","author":"Moss","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1080\/10810730.2014.936568","article-title":"Development of the health insurance literacy measure (HILM): conceptualizing and measuring consumer ability to choose and use private health insurance","volume":"19","author":"Paez","year":"2014","journal-title":"J. Health Commun."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.jval.2022.07.017","article-title":"Comprehensive score for financial toxicity and health-related quality of life in patients with Cancer and survivors: a systematic review and Meta-analysis","volume":"26","author":"Pangestu","year":"2023","journal-title":"Value Health"},{"key":"ref39","first-page":"759","article-title":"Public law","year":"2010"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.oraloncology.2016.12.014","article-title":"Depression and survival in head and neck cancer patients","volume":"65","author":"Rieke","year":"2017","journal-title":"Oral Oncol."},{"key":"ref41","volume-title":"Analyzing Qualitative Data. Chapter 9: Qualitative Data Analysis for Applied Policy Research","author":"Ritchie","year":"1994"},{"key":"ref42","volume-title":"The Coding Manual for Qualitative Researchers","author":"Salda\u00f1a","year":"2013"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","article-title":"Saturation in qualitative research: exploring its conceptualization and operationalization","volume":"52","author":"Saunders","year":"2018","journal-title":"Qual. Quant."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1814","DOI":"10.34172\/ijhpm.2021.83","article-title":"\u201cmy Cancer is worth only fifteen weeks?\u201d a critical analysis of the lived experiences of financial toxicity and Cancer in Canada","volume":"11","author":"Sayani","year":"2021","journal-title":"Int. J. Health Policy Manag."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1353\/cpr.2016.0013","article-title":"Community-guided focus group analysis to examine Cancer disparities","volume":"10","author":"Schaal","year":"2016","journal-title":"Prog Community Health Partnersh"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1007\/s00520-019-04915-w","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":"ref47","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1001\/jamaoncol.2022.5805","article-title":"Prescription drug provisions in the inflation reduction act: any relief of financial hardship for patients with Cancer?","volume":"9","author":"Shih","year":"2023","journal-title":"JAMA Oncol."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"5487","DOI":"10.1007\/s00520-021-06086-z","article-title":"Understanding the strategies rural cancer patients and survivors use to manage financial toxicity and the broader implications on their lives","volume":"29","author":"Skrabal Ross","year":"2021","journal-title":"Support Care Cancer"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1177\/1090198114557123","article-title":"Finding medical care for colorectal cancer symptoms: experiences among those facing financial barriers","volume":"42","author":"Thomson","year":"2015","journal-title":"Health Educ Behav"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"e77549","DOI":"10.1371\/journal.pone.0077549","article-title":"\u201cIt\u2019s at a time in your life when you are most vulnerable\u201d: a qualitative exploration of the financial impact of a cancer diagnosis and implications for financial protection in health","volume":"8","author":"Timmons","year":"2013","journal-title":"PLoS One"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1177\/1077800410383121","article-title":"Qualitative quality: eight \u201cbig-tent\u201d criteria for excellent qualitative research","volume":"16","author":"Tracy","year":"2010","journal-title":"Qual. Inq."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.jacr.2022.12.004","article-title":"Financial toxicity: a barrier to achieving health equity in cancer care","volume":"20","author":"Tucker-Seeley","year":"2023","journal-title":"J. Am. Coll. Radiol."},{"key":"ref53","doi-asserted-by":"publisher","first-page":"4457","DOI":"10.1007\/s00520-022-06873-2","article-title":"\u201cI thought there would be more I understood\u201d: health insurance literacy among adolescent and young adult cancer survivors","volume":"30","author":"Waters","year":"2022","journal-title":"Support Care Cancer"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"3493","DOI":"10.1002\/cncr.25209","article-title":"Forgoing medical care because of cost: assessing disparities in healthcare access among cancer survivors living in the United States","volume":"116","author":"Weaver","year":"2010","journal-title":"Cancer"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1158\/1055-9965.EPI-20-0067","article-title":"Reducing Cancer-related financial toxicity through financial navigation: results from a pilot intervention","volume":"29","author":"Wheeler","year":"2020","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1200\/JCO.2017.77.6310","article-title":"Financial impact of breast Cancer in Black versus White women","volume":"36","author":"Wheeler","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref57","first-page":"S74","article-title":"Impact of trained oncology financial navigators on patient out-of-pocket spending","volume":"24","author":"Yezefski","year":"2018","journal-title":"Am. J. Manag. Care"},{"key":"ref58","first-page":"80","article-title":"Financial toxicity, part I: a new name for a growing problem","volume":"27","author":"Zafar","year":"2013","journal-title":"Oncology (Williston Park)"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"pkz061","DOI":"10.1093\/jncics\/pkz061","article-title":"Is health insurance literacy associated with financial hardship among cancer survivors? Findings from a National Sample in the United States","volume":"3","author":"Zhao","year":"2019","journal-title":"JNCI Cancer Spectrum"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1002\/cncr.31913","article-title":"Medical financial hardship among cancer survivors in the United States","volume":"125","author":"Zheng","year":"2019","journal-title":"Cancer"}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2023.1178517\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T04:50:41Z","timestamp":1684126241000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2023.1178517\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,15]]},"references-count":60,"alternative-id":["10.3389\/fpsyg.2023.1178517"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2023.1178517","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,15]]},"article-number":"1178517"}}