Impacts of Financial Toxicity on Patients Receiving Dialysis: An Exploratory Qualitative Study.

KEY POINTS: The loss of income and surging health care expenditures exacerbate financial toxicity in patients with kidney failure undergoing dialysis. Patients experienced financial toxicity through reduced spending, social withdrawal, negative emotions, and limited treatment options. The study highlights the importance of addressing financial concerns in dialysis care.

BACKGROUND

Many patients with kidney failure experience deteriorating financial situations that affect their everyday lives. Financial toxicity (FT) provides a person-centered perspective of this phenomenon. However, little is known about this concept in the nephrology context. This study aimed to explore the impact of FT in patients receiving dialysis.

METHODS

This exploratory qualitative study purposively recruited patients on long-term dialysis on the basis of their treatment modalities and socioeconomic levels from three centers in Hong Kong. Individual semistructured interviews were conducted using an interview guide. Recordings were transcribed verbatim, and transcripts were analyzed using a thematic analysis approach.

RESULTS

Twenty-five patients were interviewed. Three themes emerged, namely, contributors, experiences, and mitigators of FT. FT was commonly triggered by decreased employment/income and increased health care expenditures. While experiencing FT, patients often reduced their spending, avoided social activities, perceived negative thoughts and emotions, and reconsidered their treatment options. To mitigate these impacts, patients used personal resources and various assistance/subsidy schemes. FT was more marked if the patient was unable to obtain public financial assistance. Of note, patients who were given information about the financial aspect of dialysis were better able to cope with FT.

CONCLUSIONS

Deteriorating financial situations have multidimensional impacts on the material, psychological, and behavioral aspects of patients' lives. Although efforts are warranted to make health care systems more equitable, interventions to alleviate these impacts are not limited to monetary assistance. They can include practical support for coping with life changes and planning personal finances.