Govind Persad, JD, PhD
Beyond the physical toll of the disease and its treatments, cancer often presents a host of legal and social issues that can significantly worsen a patient’s well-being and treatment outcomes. This column explains how medical-legal partnerships can offer a powerful tool to address these challenges holistically. In doing so, medical-legal partnerships can improve health and overall outcomes for oncology patients.
One common model for medical-legal partnerships integrates lawyers into health-care teams to help address health-harming legal needs with civil legal remedies. According to the National Center for Medical-Legal Partnership, a health-harming legal need is a “social problem that adversely affects a person’s health or access to health care and is better remedied through joint legal care and health care than through health-care services alone.”1
A survey of medical-legal partnerships explains that such partnerships have been adopted in more than 300 hospitals as well as by clinics, public health agencies, and health systems.2 The survey identified the following eight core elements of medical-legal partnerships:
- A formal agreement between health-care organizations and legal service providers;
- A defined population to be served;
- A strategy to screen patients for legal needs;
- Legal staffing provided by the legal services organization;
- Lawyers in residence at the site of health-care provision;
- Training for health-care professionals on identifying legal issues for referral;
- Information sharing among legal and medical professionals;
- Financial support (often from both health and legal organizations).
Oncology medical-legal partnerships can either constitute special population medical-legal partnerships that focus on patients with distinctive legal needs or alternative models that depart from some of these core elements.
Tackling the Legal Issues Affecting Patients With Cancer
In the context of oncology, medical-legal partnerships can provide crucial support to patients with cancer by tackling legal issues that directly or indirectly affect their health and treatment and can benefit them in numerous ways. For example, cancer treatments often lead to extended hospital stays. Patients who are immunocompromised due to chemotherapy in particular need a clean, stable living environment once they leave the hospital to prevent infections.
Medical-legal partnerships can aid patients facing eviction, unsafe housing conditions, or difficulty securing appropriate housing accommodations by helping them to vindicate their legal rights or navigate benefit programs. Many patients with cancer also struggle with work-related issues during treatment. Lawyers in medical-legal partnerships can assist with understanding and securing medical leave, addressing workplace discrimination, and negotiating reasonable accommodations.
Navigating the Complex World of Health Insurance
Insurance and financial assistance for health services are other areas where medical-legal partnerships can provide valuable support. They can help patients navigate the complex world of health insurance, including appealing denied claims, understanding coverage options, and accessing financial assistance programs. End-of-life planning is also particularly crucial for many patients with cancer. Medical-legal partnership lawyers can assist with creating or updating wills, establishing power of attorney, and drafting advance directives—all needs that patients view as among the most important.
For patients with uncertain immigration status, medical-legal partnerships can provide guidance on accessing care and navigating the health-care system without jeopardizing their status. Cancer can also put a strain on family relationships, and medical-legal partnerships can assist with child custody arrangements, domestic violence protection, and guardianship for minor children.
Identifying Patients Who Need Legal Assistance
By understanding the scope of medical-legal partnership services, oncology professionals can identify patients who might benefit from legal assistance and refer them to lawyers on the care team or to an outside medical-legal partnership program. This might involve making a formal referral or simply informing the patient about available services. Professionals may be called upon to provide medical information or context to the legal team. Their insights into a patient’s condition and needs can be invaluable in addressing legal challenges.
Additionally, oncology professionals can help patients understand how addressing legal issues might improve their health outcomes and support them through the process of working with legal professionals. One appealing option for developing medical professionals’ ability to work as partners in medical-legal partnerships is to integrate medical-legal partnership training into medical school and residency training.3 Another is to develop and cultivate academic medical-legal partnerships to leverage service, education, and research resources to advance health justice.4
Integrating Medical-Legal Partnerships Into Patient Care
Bringing medical-legal partnerships into oncology practice requires careful planning and collaboration. Oncology departments or cancer centers can partner with local legal aid organizations, law schools, or pro bono programs, for example, the ABA Medical-Legal Partnerships Pro Bono Project (www.americanbar.org/groups/probono_public_service/projects_awards/medical_legal_partnerships_pro_bono_project), to create medical-legal partnerships.
One source of support is the Health Resources and Services Administration (HRSA.gov), which “offers free training and technical assistance to health centers interested in forming or expanding a partnership through a national cooperative agreement with the National Center for Medical-Legal Partnership.” Another medical-legal partnership resource for patients with cancer is the National Cancer Legal Services Network (legalhealth.org).
Medical-legal partnerships work best when seamlessly integrated into patient care. This might involve adding legal screening questions to intake forms, including legal professionals in multidisciplinary team meetings, and creating clear referral pathways. However, strict protocols must be established to maintain patient confidentiality and address potential ethical concerns when sharing information between medical and legal professionals.
Evaluating Relevant Outcomes
Tracking results is crucial for demonstrating the value of medical-legal partnerships. This might include monitoring the number of patients served, types of legal issues addressed, impact on treatment adherence and outcomes, and patient satisfaction. Evidence indicates that medical-legal partnerships can improve financial outcomes, such as debt relief and reduced utility shutoffs, as well as health outcomes, such as reduced patient stress and fewer hospital readmissions and emergency department visits.
A recent study investigating the legal needs of people with cancer found that about 75% of study participants had at least one legal need, with financial legal concerns, housing, and employment issues the most frequently reported legal needs identified among the study participants.1
The efficacy of oncology-related medical-legal partnerships at addressing patient needs remains understudied, with recent research highlighting the importance of program evaluation. Program evaluation could incorporate a variety of relevant outcomes, such as financial stability and ability to keep appointments, and even familiar outcomes, such as improved survival. Reduction in cancer-related health disparities is another relevant endpoint.
Overcoming Challenges
Although medical-legal partnerships offer significant benefits, there are challenges to consider. Securing sustainable funding for legal services can be difficult. Some medical-legal partnerships rely on grants or pro bono work, which may limit their capacity; studies have explored approaches to secure more reliable funding, such as through managed care contracts or funding from large-scale payers.2 Determining which patients receive limited legal resources can be challenging and may require careful triage. Both medical and legal professionals need to be culturally competent to serve diverse patient populations effectively. Adding legal screenings and interventions to already busy clinical workflows can also be challenging.
Ultimately, however, medical-legal partnerships offer a powerful tool for addressing the complex needs of patients with cancer. In a recent article, one comprehensive cancer center director suggested that all cancer centers should adopt medical-legal partnerships as part of their care approach.3 Understanding and embracing the potential of medical-legal partnerships can help oncologists offer more comprehensive, patient-centered care that addresses not just the medical aspects of cancer, but the broader social and legal challenges patients face. Integrating legal support into oncology care teams can help ensure that patients have the best possible chance at focusing on their health and recovery, unburdened by legal issues that might otherwise impede their treatment and well-being.
DISCLOSURE: Dr. Persad receives grant funding from the Greenwall Foundation.
REFERENCES
1. Dowling AB, Jensen CS, Sweeney A, et al: Legal needs and health outcomes for people with cancer in medical-legal partnership programs: A systematic review. J Health Care Poor Underserved 34:1105-1120, 2023.
2. Regenstein M, Trott J, Williamson A, et al: Addressing social determinants of health through medical-legal partnerships. Health Aff (Millwood) 37:378-385, 2018.
3. Bin Han Ong M: Solving problems doctors can’t fix: How Georgetown’s medical-legal partnership saves lives by including lawyers on cancer care teams. The Cancer Letter, August 2, 2024. Available at https://cancerletter.com/health-equity/20240802_1. Accessed November 1, 2024.
4. Girard VW, Cannon YZ, Perry DF, et al: Leveraging academic-medical legal partnerships to advance health justice. J Law Med Ethics 51:798-809, 2023.
Editor’s Note: The Law and Ethics in Oncology column is meant to provide general information about legal topics, not legal advice. The law is complex, varying from state to state, and each factual situation is different. Readers are advised to seek advice from their own attorney.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.
