Colorectal Cancer Legal and Administrative Burden Support (COLLABS): A Pilot Clinical Trial

Abstract

Purpose: Engagement with legal teams after a cancer diagnosis-medical-legal partnerships (MLPs)-can identify, prevent, and resolve health-harming legal needs (HHLNs). Cancer Legal Care (CLC) is a nonprofit providing free legal services to persons affected by cancer in Minnesota. We sought to conduct a pilot study of delivering proactive and free legal support through CLC.

Methods: We conducted a single-arm, mixed-methods pilot study to assess the feasibility and acceptability of delivering legal support, and preliminary efficacy in addressing HHLNs to 20 adults with advanced-stage colorectal cancer. CLC staff conducted an initial screening visit, crafted an individualized plan, and provided structured as well as personalized legal support over the 6-month study period. We collected patient-reported outcomes (assessing comfort with health-related tasks, financial toxicity, stress, coping, and self-esteem) at baseline, 3 months, and 6 months, and conducted end-of-study interviews to explore participant experiences.

Results: The study met predefined feasibility (90% of participants completed initial screening visit, 90% remained engaged, 80% completed the study) and acceptability (81% of participants recommended the intervention to others) benchmarks. The initial legal checkup visit lasted a median of 45 minutes, 61% self-identified HHLNs, and CLC attorneys identified additional HHLNs for 72%, with median 3 HHLNs per participant. On the basis of participant preference, 100% of visits were virtual, with attorneys spending a median 3.5 hours per participant, often also supporting individuals with administrative burdens and providing emotional support. After the 6-month study period, participants expressed greater comfort with tasks such as addressing unexplained bills, guardianship planning, and ensuring insurance coverage compared with baseline. Participants noted very high satisfaction with the interpersonal relationships with CLC staff, felt empowered and supported, and suggested including informal care partners in future work.

Conclusion: Proactive legal care to address HHLNs through a MLP was feasible, acceptable, and valued by patients. Despite no requirement for baseline legal need, HHLNs were prevalent and addressable. This work underscores the importance of further study on how interdisciplinary teams can best deliver sociolegal care to persons with cancer.