Patient-Proposed Solutions to Financial Toxicity After Surgery: A Longitudinal, Multicenter Qualitative Study

Financial toxicity (FT) is the economic burden of medical care that negatively affects patients' well-being and quality of life. FT disproportionately impacts surgical patients. Although prior studies have quantified FT, few have explored patient-identified interventions to mitigate it. This study explores solutions to FT through qualitative interviews with surgical patients.

A multicenter prospective study was conducted to characterize FT in adult surgical trauma patients across three tertiary care centers in India. A total of 854 patients were surveyed. Semi-structured interviews were conducted amongst a randomized subset of these patients within 1 year of surgery. Interviews were recorded, transcribed, translated, and coded. Recurring themes were identified using a qualitative thematic analysis with a deductive approach.

A total of 39 patients were interviewed, with a median age of 37.7 years (SD 14.6). Almost all reported needing to borrow money or sell assets to cope with FT resulting from surgical care, leading to long-term social distress. Themes for patient-proposed solutions emerged: (1) addressing insurance deficits, (2) providing direct non-medical cost support, (3) increasing social support schemes, and (4) infrastructure for acute financial assistance.

Surgical trauma patients in India face substantial postoperative FT, necessitating contextualized solutions. Increasing awareness and use of existing government schemes is crucial. Patients facing FT should be identified upon admission and educated about financial options. Comprehensive support strategies such as governmental resources, monetary support systems, and social services are essential. Implementing patient-reported solutions to mitigate FT is vital to improving patient outcomes after surgery.