Self-reported Determinants for Subjective Financial Distress: A Qualitative Interview Study with German Cancer Patients

Abstract Purpose. Patient-reported financial effects of a tumor disease in a universal healthcare setting are a multidimensional phenomenon. Actual and anticipated objective financial burden caused by direct medical and non-medical costs as well as indirect costs such as loss of income, can lead to subjective financial distress. To better understand the reasons for subjective financial distress and to identify aggravate (obstacles) and preventive (resources) determinants, the present study inquires how cancer patients interpret and explain the level of subjective distress due to financial consequences of their disease. Methods. Semi-structured interviews with n=18 cancer patients were conducted between May 2021 and December 2021. Patients were recruited based on a purposive sampling strategy in outpatient and inpatient settings. The interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Results. When explaining the degree of their subjective distress, interviewees refer to both distress-preventing and distress-increasing influencing determinants. Distress-preventing factors are material, social and systemic resources such as access to social and health care service; cognitive coping strategies ; personal character traits and change of attitude . Distress was increased by administrative hurdles and expected objective financial burden . Conclusion. Subjective financial distress depends on material, social, systemic and personality-specific determinants. To address them, not only individual counselling is needed, but also socio-political changes. Trial registration number NCT05319925