Background Traumatic hand injuries can result in substantial harms to patients’ functional abilities and financial health, disproportionately affecting individuals who are of working age, low income, and uninsured. However, little is known about how patients and their families cope with the functional limitations and economic consequences that follow, and how these injuries affect patients’ mental and emotional health. Exploring clinician and staff perceptions about the impact of traumatic hand injuries on patients may provide insight into how to help address the various burdens patients face. Questions/purposes In this paper, we aimed to explore the following questions: (1) What is the impact of a traumatic hand injury on patients’ financial health? (2) How does a traumatic hand injury affect patients’ physical health and disability? (3) What kind of toll does a traumatic hand injury take on patients’ emotional and mental health? (4) What health system challenges function as additional stressors after a traumatic hand injury? Methods This descriptive study consisted of surveys and semistructured interviews. We recruited patients from an outpatient hand surgery clinic at a safety-net hospital in a southern US city. Eligible patients were English- or Spanish-speaking, age 18 years or older, who presented to the clinic after a traumatic hand injury. Between January and April 2025, we invited patients to participate in three surveys that assessed financial burden and upper extremity disability: the Comprehensive Score for Financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT), the DASH questionnaire, and the InCharge Financial Distress/Financial Well-Being Scale. Of 94 surveys offered, 88% (83) of surveys were completed. The mean ± SD patient age was 38 ± 13 years. Forty-five percent (37 of 83) of participants spoke English, 55% (46 of 83) spoke Spanish, 82% (68 of 83) identified as Hispanic or Latino (any race), 70% (58 of 83) were male, and 58% (48 of 83) relied on the safety-net institution’s county charity program for coverage of medical expenses. We completed 26 interviews with patients and 10 interviews with clinicians and staff (three physicians, three clinical staff, one nonclinical staff, and three finance staff), each lasting a median (range) of 24 minutes (13 to 54), while 11 patients and four clinicians and staff declined to participate because of lack of time or interest. Among interview participants, the mean ± SD participant age was 39 ± 15 years. Fifty-four percent (14 of 26) spoke English, 58% (15 of 26) identified as Hispanic or Latino (any race), 65% (17 of 26) were male, and 42% (11 of 26) relied on the county charity program. All statistical analyses were performed using R, version 4.5.0, with p < 0.05. A convenience sample of clinic patients was invited to participate in semistructured interviews, as was a purposive sample of clinicians and staff. Eligible clinicians and staff were those who had been employed at the safety net for at least 1 year. Between August and October 2024, interviews were conducted in English and Spanish and audio-recorded. During qualitative data collection, interviewers documented findings using a rapid data analysis matrix, and at the conclusion of data collection, we conducted thematic content analysis to analyze findings more in depth, select exemplar quotes, and facilitate interpretation. Results Survey data indicated that 22% (18 of 83) of patients reported high levels of financial toxicity after their traumatic hand injury, defined as a COST-FACIT score of < 23. Interviewed patients spoke about how their injury impacted their ability to pay for groceries, household bills, and recreational activities. Each shared various coping strategies to navigate these financial challenges, such as relying on their social network or finding side jobs. We found that 65% (54 of 83) of patients reported severe upper-limb disability after their injury, which led to limitations in their ability to work or perform daily activities. Fifty-four percent (29 of 54) of all patients had charity care with a copayment. Patient narratives also described the impact of their financial burdens and disability on their mental health, as well as those of their loved ones around them. Clinicians, staff, and patients reported shared health-system challenges, particularly around the lack of adequate and efficient financial processes that could help patients access social support tools and funding. Conclusion Our findings indicate that, in addition to financial toxicity, traumatic hand injury created a cascade of emotional and daily living challenges for patients at a safety-net institution and for their family members that impacted their well-being far beyond the period of injury. These findings suggest the need for the healthcare system to enhance the intensity and sustainability of social services support postoperatively, including the potential use of ongoing social services screening tools and referral to community-based organizations. Level of Evidence Level II, therapeutic study.
Higashi et al. (Tue,) studied this question.