Resident Brody School of Medicine at East Carolina University Greenville, North Carolina, United States
Disclosure: Disclosure information not submitted.
Participants should be aware of the following financial/non-financial relationships:
Scarlett B. Hao, MD: Disclosure information not submitted.
Introduction: Routine screening for social determinants of health (SDOH) in the outpatient oncology setting is uncommon, and the prevalence and burden of individual SDOH needs among patients with cancer remains poorly understood. The primary study aim was to evaluate the feasibility of implementing an electronic health record (EHR) instrument designed to measure SDOH into routine clinical practice.
Methods: A prospective study was performed of all adult patients with a newly diagnosed gastrointestinal malignancy presenting to a regional cancer center (11/2020-7/2021). SDOH screening was administered by a nurse navigator, social worker, or medical student using the EHR. Primary outcome measures included % eligible patients screened, median clinic visit time, and acceptability to the interprofessional care team as measured by structured interviews. Secondary outcomes included number of SDOH needs per patient and subsequent interventions.
Results: Of 118 eligible patients, 113 (95.8%) were successfully screened for SDOH. Nearly half self-identified as Black (40.7%; n=46) and the remainder White (58.4%; n=66); 4.4% (n=5) were uninsured and 17.7% (n=20) Medicaid-insured. Median visit time was 97 minutes (95%CI 70-107) before implementation and 100 minutes after (95%CI 75-119; p=0.95). Team members reported no significant clinic disruptions and were supportive of ongoing use. Most patients had 2-3 total needs with 1-2 moderate and 1-2 severe needs. A subset of patients had a high burden of needs (4 needs, n=21; < ![if !msEquation] > < ![endif] >5 needs, n=13). Most common severe needs included physical activity (n=62), stress (n=55), tobacco use (n=23), and food insecurity (n=9). Most common moderate needs included social connections (n=76), tobacco use (n=44), physical activity (n=21), and financial strain (n=12). Resources were offered to 20 patients (17.6%) to address SDOH needs.
Conclusions: Routine collection of SDOH in an outpatient oncology setting using an EHR instrument is feasible and non-disruptive to workflow. Further investigation to determine if standardized SDOH assessment can improve cancer care delivery on an individual and population level is ongoing.
Learning Objectives:
recognize that implementation of routine social determinants of health screening using the electronic health record does not impede clinic workflow
appreciate the prevalence of SDOH needs among patients with gastrointestinal cancer
describe commonly identified SDOH needs in the gastrointestinal cancer patient population
