Towards the Assessment of Subjective Financial Distress due to a Tumor Disease. A Conceptual Model of the Financial Effects of Cancer on Patients in Germany

Abstract Purpose A conceputalisation of subjective financial distress as a consequence of a cancer diagnosis and treatment is still missing due to a lack of a comprehensive model accounting for all relevant dimensions of financial effects of cancer experienced by patients. Our goal was to derive a model for the German healthcare system to shed light on the complex process of financial effects of cancer. Methods The model was developed through systematic literature review and qualitative studies, including inter-views with 18 cancer patients and a focus group with 4 social services representatives. The iterative process of model development was accompanied by an ongoing exchange in the interdisciplinary research team. Results The developed model of financial effects of cancer experienced by patients consists of three dimensions: 1) actual and anticipated financial disadvantages, 2) behavioural and cognitive coping strategies, and 3) subjective financial distress conceptualised as negative effects in different aspects of daily living: employment, living situation, family, social participation, health promoting lifestyle, additional personally preferred treatments, navigating the health system and a further area so-called unspecific. Conclusion Subjective financial distress is driven by different financial effects of cancer experienced by patients and is perceived as negative in various aspects of daily living. While the identified categories of daily living can be observed in countries with universal healthcare coverage, the content and degree of each subcategory depends on country-specific characteristics. The introduced model can be used to inform the development of a new PROM. Trial registration number NCT05319925 (regristration date: 2022-06-01)