Date of Conferral





Human Services


Magdeline Aagard


Financial toxicity (FT) is the impact that out of pocket (OOP) costs of cancer care have on patients' well-being, leading to lower quality of life, less compliance with prescribed therapy, and poorer outcomes, including increased mortality. The purpose of this study was to understand the impact of FT on advanced cancer patients' lives and their health care decision-making. Fuzzy trace theory provided the framework for examining how patients use gist and verbatim when making health care decisions while experiencing FT. Gist refers to main ideas that are often infused with emotional overlays that people use to make risky decisions, while verbatim thinking involves the recall of precise facts and figures to make decisions. The research method was case study that included conducting 13 in-depth interviews, collecting artifacts, and scoring of FT using the Comprehensive Score for Financial Toxicity tool. Findings from two-cycle coding and cross-case analysis indicated that FT and OOP costs have significant impacts on patients' lives and how they make decisions about their cancer care. Participants considered cost as a risk in cancer treatment decisions and encoded this information using verbatim rather than gist, which they used for other dimension of risk in these decisions. Participants reported they would decline care if OOP costs were high and FT was present. When OOP costs were low, participants relied on gist decision-making and generally followed their physicians' recommendations. Findings may assist cancer experts who are investigating FT and its impact on cancer care as well as those who are developing support programs for patients who experience FT.