Financial strain is the single most important factor in making health-care decisions for low-income individuals, who often forgo care in favor of basic needs like food and rent, researchers in UT Southwestern’s Center for Patient-Centered Outcomes Research (PCOR) found.

In addition, low-income individuals are often reluctant or too embarrassed to discuss their financial hardships and constraints with caregivers during office visits. As a result, physicians and caregivers frequently misinterpret that choice as noncompliance with medical care.

“Financial strain is the burden that prevents many low-income patients from being able to take better care of themselves,” said lead author Dr. Oanh Nguyen, assistant professor of internal medicine and clinical sciences at UT Southwestern Medical Center. “This financial strain can cause nonadherence to physician recommendations that appear to reflect a patient’s lack of engagement in care. However, this ‘nonadherence’ is actually the result of rational and difficult trade-offs to cope with financial strain.”

To combat the reluctance to discuss financial strain, physicians should take the lead in recognizing and “diagnosing” financial strain, the authors recommended.

“We believe our findings will help physicians better recognize the signs and symptoms of financial strain in patients, so that they can create a safe environment for patients to overcome their embarrassment by discussing these concerns and work with their patients to develop the best plan of care that works within the patient’s financial means,” said Dr. Nguyen. “For instance, discussing which medications cost more or less and which are safe to skip or stretch if necessary.”

Researchers conducted 12 focus groups among individuals seeking services at Crossroads Community Services, a local nonprofit organization providing food assistance and other support to low-income families in Dallas. Most participants were in their 40s and 50s. Sixty-seven percent were women, 5% were white, 38% were black, and 56% were Hispanic. Findings from the PCOR study appear in the Journal of General Internal Medicine.

Next steps include development of analytic algorithms to help health-care teams recognize when an individual may be unable to adhere to medical recommendations due to the presence of financial strain and other unmet basic needs.