Financial toxicity after trauma and acute care surgery: recommendations for measuring long-term financial hardship

Many patients experience financial hardship after acute injuries or emergency surgery. Financial hardship, often referred to as "financial toxicity," comprises material hardship due to unexpected bills and income loss, psychosocial stress due to uncertainty of one's financial future, and negative coping behaviors such as forgoing necessary care due to costs. These factors combine to have detrimental effects on physical and mental health and prevent optimal recovery after injury or illness. Although there is a growing appreciation that acute care surgeons should understand and evaluate financial hardship in their own populations to facilitate the optimal recovery of their patients, consensus is lacking on the best ways to measure financial hardship among the trauma and emergency surgery patient population. This current opinion will define the scope of the problem and provide pragmatic first steps to enable the evaluation of long-term, patient-level financial outcomes at your institution-including specific questions that encompass the five domains and the five mediators of financial hardship. This effort presents an updated theoretical framework, challenges common terminology, and synthesizes the most relevant tools for measuring financial hardship, presenting recommended screening questions that can be immediately used to assess long-term financial outcomes in trauma and emergency surgery populations, and standardizing data collection across institutions and facilitating larger-scale investigations.