Cancer, Health Insurance, Health Literacy, Health Services Accessibility, Informed Decision Making
Conditions
Keywords
Decision Making, Decision Support, Health Literacy
Brief summary
The goal of this research study is to find out if a decision aid (DA) created by investigators, I Can PIC, is effective in helping cancer patients make decisions about their health insurance. The investigators will evaluate I Can PIC compared to an attention control condition (existing website created by the American Cancer Society Cancer Action Network). The study hypothesis is that those randomly assigned to I Can PIC will have higher knowledge about health insurance terms and details, more certainty about the best health insurance plan for them, and more confidence in their health insurance decisions compared to those randomly assigned to the control condition.
Detailed description
In a prior study, the investigators created a consumer-friendly online tool, Show Me Health Plans (SMHP), for those enrolling in health insurance in the ACA marketplace. I Can PIC was developed based on SMHP, with input from an advisory board, and incorporating feedback from semi-structured qualitative interviews with cancer survivors. The investigators created I Can PIC to focus on unique needs of cancer patients and survivors considering health insurance. In this study, the investigators will examine the effectiveness of I Can PIC by conducting a randomized experiment with 275 participants. The trial will compare the I Can PIC to an attention control website developed by the American Cancer Society Cancer Action Network. Primary outcomes include knowledge, decision self-efficacy, certainty about plan choice, and the match between plan choice and preferences. The investigators will also explore whether financial toxicity, cancer type, and time since diagnosis relate to outcomes.
Interventions
BEHAVIORALI Can PIC
Participants will be shown (on a computer or via email link) a website called I Can PIC. I Can PIC provides health insurance education, suggests ways to learn about the costs of cancer care and follow-up, shows resources to help offset the high costs of care, and helps individuals estimate (based on national data) how much they might spend on health insurance in the upcoming year.
Sponsors
American Cancer Society, Inc.
Washington University School of Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 64 Years
Healthy volunteers
Yes
Inclusion criteria
* Ability to read English * Diagnosed with cancer in the past 5 years * Residing in Missouri or Illinois
Exclusion criteria
* Eligible for Medicaid or Medicare in Missouri or Illinois * Enrolled in the following types of health insurance plans: Medicare, Medicaid, TRICARE or other military healthcare, or Indian Health Services
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Knowledge Score | Completed immediately after using I Can PIC | The percent correct out of eight questions that were created by the research team based on information that is considered vital to making health insurance decisions. |
| Decision Self-efficacy | Completed immediately after using I Can PIC. | The validated decision self-efficacy scale will be used. This 11-item scale measures an individual's self-confidence or belief in their ability to make a decision. Individuals will be asked to rate how confident they feel taking actions involved in making an informed choice (e.g., gathering information, asking questions, and expressing opinions). |
| Certainty about Choice (Decisional Conflict Scale) | Completed immediately after using I Can PIC | The validated, 4-item SURE Test for clinical practice will be used. This scale measures whether individuals feel they have enough information to make a choice, are clear about their values for risks and benefits of their choice, and feel they have enough support to make a choice. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Knowledge Score | 3 month follow-up | The percent correct out of eight questions that were created by the research team based on information that is considered vital to making health insurance decisions. This measure will be assessed at follow-up to see if differences observed between groups immediately post-intervention, remain at follow-up. |
| Health Insurance Literacy Measure | Completed immediately after using I Can PIC | Two items from the validated Health Insurance Literacy Measure will be used. This scale measures consumers' confidence in their ability to estimate their annual health care costs and their understanding of health insurance terms. |
| Certainty about Choice (Decisional Conflict Scale) | 3 month follow-up | The validated, 4-item SURE Test for clinical practice will be used. This scale measures whether individuals feel they have enough information to make a choice, are clear about their values for risks and benefits of their choice, and feel they have enough support to make a choice. This measure will be assessed at follow-up to see if differences observed between groups immediately post-intervention, remain at follow-up. |
| Choice of Health Insurance Plan | Completed immediately after using I Can PIC | Participants will be asked what health insurance plan they would choose. Plan selections will be categorized by the type of plan, e.g., high deductible plan, PPO, silver-tier Marketplace plan, gold-tier Marketplace plan, and will be compared to our algorithmic prediction about good fit plans for users based on estimates of their health care expenses. |
| Healthcare Utlization | 3 month follow-up | Participants will be asked questions about how often they use healthcare services to see if their plan choice relates to their utilization |
Countries
United States
Outcome results
None listed