Cancer, Vulnerability, and Financial Quality of Life: A Mixed Methods Study
For people who are experiencing financial hardship, a cancer diagnosis can be devastating. For others, cancer may exacerbate financial stress, thereby influencing their livelihoods and their ability to maintain employment benefits (including health insurance), manage financial obligations, and participate meaningfully in cancer treatment. Financial quality of life is conceptualized here as the ability to manage all current obligations related to cancer care, within the context of sound health-care decision making. The purpose of this mixed methods study is to examine this concept in an availability sample of 90 cancer patients. In the quantitative portion, the variables that are hypothesized to affect financial quality of life include housing stability; one's sense of personal control within the larger context of health locus of control; demographic information; income/financial stress; health insurance adequacy; perceived barriers to care; social support; cancer diagnosis and acuity; and perceived ability to participate meaningfully in treatment. These variables fit within the adapted behavioral model for vulnerable populations by Gelberg, Andersen, and Leake (2000). The study is also underpinned philosophically by the difference and opportunity principles of John Rawls (1971, 1999). Bivariate correlations were examined, and multivariate analysis (ordinary least squares) was used to examine the impact of all the predictor variables on the criterion variable. The qualitative portion was an interview with seven participants from the quantitative portion. Content analysis was used to elicit the themes expressed. There were significant correlations between financial quality of life and age; housing stability; income below $10,000; health insurance adequacy; perceived barriers to care; social support; financial stress (distinct from financial quality of life); and selected aspects of treatment adherence. The multivariate regression analysis found that gender, housing stability, health insurance adequacy; fewer barriers to care; reduced financial stress; and the intentions and support/barriers aspects of treatment adherence are significant predictors of financial quality of life. Themes that emerged from the qualitative analysis (across incomes) revolved around the importance of social support; hope; creative frugality in living within one's means; dedication to treatment; and a strong sense of personal control. The research showed that this theoretical model is useful for future health-related research.
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