DISCO: A Patient Intervention to Reduce the Financial Burden of Cancer

Aim 1: Using a RCT, determine the effectiveness of the Discussions of Cost App (DISCO App) on shortterm outcomes at three levels:

• patient (treatment cost knowledge, self-efficacy for managing cost and physician interactions, and perceived financial toxicity [cost distress, material hardship]);
• patient-oncologist interaction (patient active participation; frequency and quality of patient-initiated cost discussions with oncologists; oncologists’ patient-centered communication as observed in video recordings); and
• healthcare utilization (social work/financial navigation referrals, social work/financial navigation referral uptake).
• H1a: We hypothesize that the DISCO App will improve outcomes for all intervention patients, and
• H1b: Black patients will experience greater improvement than White patients, lower-income patients will experience greater improvement than higher-income patients, and younger patients will experience greater improvement than older patients.

Aim 2: Determine the effectiveness of the DISCO App on longer-term outcomes (financial toxicity, treatment adherence, and clinic appointment adherence). We will compare longer-term outcomes across arms.

• H2a: We hypothesize that: patients receiving the DISCO App + booster will experience the greatest improvement in outcomes, followed by patients receiving the DISCO App, and last, usual care; and that
• H2b: Black patients will experience greater improvement in outcomes than White patients.

Aim 3: Test potential mediators and moderators of the relationship between the short-term and longerterm outcomes of the DISCO App.

• H3: We hypothesize that the DISCO App will increase the frequency and quality of patient-initiated cost discussions, which will increase social work/financial navigation referrals, social work/financial navigation referral uptake, and patient self-efficacy for managing treatment cost, which in turn will reduce financial toxicity and improve adherence.
• H4: We hypothesize that this relationship will be moderated by patient socio-demographic characteristics.