Refining AYA-NAV, an AYA-tailored needs navigation intervention: Findings from co-design sessions.

398 Background: Adolescents and young adults (AYAs) face significant financial hardship during and after cancer treatment compared to older adults with cancer due to unique life-stage considerations. In a small feasibility pilot, we showed that our AYA-tailored needs navigation intervention (AYA-NAV) was feasible with early indication of efficacy in reducing financial toxicity scores. Prior to conducting a phase 2 randomized pilot feasibility trial, we sought to refine the intervention and explore opportunities for digital health components to bolster scalability. Methods: Sequential co-design sessions were conducted with AYAs and caregivers in English and Spanish online via Zoom. Participants were shown a case study of an AYA with financial hardship and unmet needs and prompted to state what would be most helpful, how it would be delivered, and how to prioritize multiple unmet needs. AYA-NAV was then introduced, and moderators further prompted the discussion to assess optimal communication modes, messaging content, and follow up frequency. Sessions were audio recorded, transcribed, and coded to identify recommended refinements to the AYA-NAV intervention model. Results: Co-design sessions were conducted with 10 AYAs (mean age 31 years [range 19-40]) and 6 caregivers (mean age 43 years [range 35-49]) over 2 months, across 6 one-hour focus group sessions. Sessions were conducted in English (n = 4) and Spanish (n = 2). Three topics for intervention refinement were identified: importance of human delivered intervention, tailoring for AYA needs and preferences, and ongoing assessment of engagement and changing needs/preferences. Recommendations offered by AYAs included: 1) offer in-person onboarding during initial participation or, if not feasible, zoom options for face-to-face delivery to promote engagement; 2) communication preferred by text but personalized so they know there is a “human on the other side;” and 3) periodic reassessment of communication preferences and prioritization of needs; and by caregivers: 1) deliver resource information via email in batches or, if needed, all at once; email follow up reminders and supplemental information; and 2) delay vocational (specifically school-based) needs navigation until later in treatment trajectory for overwhelmed caregivers. Conclusions: AYAs and caregivers provided insight for refinement of AYA-NAV intervention, including the balance between human-delivered and digital supports, prior to a randomized controlled trial. Suggestions will be applied to study protocol and will inform study fidelity and engagement metric tracking in the upcoming trial.