Frontline insights into patient legal vulnerabilities: A qualitative study of oncology provider perspectives.

394 Background: Patients with cancer face barriers requiring legal navigation. While healthcare workers (HCWs) are often asked about these issues, fewer than half report feeling comfortable navigating finances, health and disability insurance, employment, and related challenges. This qualitative study explores providers’ views on patients’ most pressing legal concerns. Methods: We conducted a qualitative study of HCWs attending free, attorney-led trainings held by the nonprofit Triage Cancer between 2021-24. HCWs answered, “What is the biggest concern your patients have with respect to insurance and finances?” We used inductive coding to identify key themes and logistic regression to assess factors associated with legal concerns. Results: Among 1342 HCWs (49% white, 69% female), respondents included social workers (41%), clinical navigators (13%), nurses (11%), and non-clinical navigators (11%) across diverse practice settings. Thematic saturation was reached at 500 samples. Most HCWs cited 1 concern (54%); fewer reported 2 (31%) or 3 (11%). Two main themes emerged: affordability (62%) and insurance (44%) (Table). Fewer responses cited job loss (10%), navigation (9%), and disability insurance (7%). Compared to social workers, financial counselors (OR 1.7, 95% CI [1.0-2.8]) and non-clinical navigators (OR 1.6, [1.1-2.4]) more often identified financial concerns while clinical navigators (OR 1.4, [1.0-2.0]) more likely reported insurance issues. Social workers more often noted employment, disability insurance, and navigation concerns. Conclusions: This is the first national study examining HCW perspectives on legal concerns of patients with cancer. Education and interdisciplinary support may be key to improving outcomes and provider confidence. Qualitative assessment. Theme Subthemes Frequency (%) Representative Quote Financial Treatment, medication costs, utilities, transportation, OOP costs, assistance 836 (62) “ Most of our pts are living right on the line, without room for extra expenses. Sometimes they have to choose between eating, paying for electricity, or medication .” Health Insurance Options, denials, underinsurance, gaps, access 590 (44) “ Ensuring insurance includes our facility in their network .” Employment Job loss, insurance loss, medical leave 134 (10) “ They lose employer sponsored private insurance, but income is too high for Medicaid and COBRA is too expensive .” Disability Insurance Long/short-term disability, social security income 93 (7) “ Navigating FMLA, disability and social security is difficult .” Navigation Patient health literacy, provider knowledge 125 (9) “ Patients ask questions about benefits, options, secondary insurance, appeals and I don't feel comfortable answering these .” Other Undocumented status, quality of life, estate planning 57 (4) “ Undocumented individuals getting access to needed medical services and treatment .”