Integrating social drivers of health screening into ambulatory cancer care

BACKGROUND: Despite the known impact of social drivers of health (SDoH) on cancer related outcomes, the integration of SDoH screens into routine oncology clinical practice is scarce and suboptimal. This study describes a retrospective analysis of a quality initiative that integrated a SDoH screener and referral system into clinical workflow and patient outcomes. 

METHODS: In a quality improvement initiative, a 17-item Quality of Life and Support survey was developed and sent out via the patient portal 7 days prior to patients' second oncology appointment, with repeat measures every 90 days. Descriptive statistics were used to describe patients who completed versus didn't complete the survey and escalated surveys. A logistic regression estimated the odds of survey completion. 

RESULTS: 10,655 patients were assigned 25,353 surveys across 5 sites. 37% of the assigned surveys were completed with 6,179 individuals completing at least one survey, 43% before the appointment date. The most frequent reasons for survey escalation were distress, financial strain, and transportation. Completing at least one survey was associated with 33% (p < 0.000) and 19% (p < 0.05) lower odds for African American/Black and Asian individuals, respectively, compared to Whites. Completing at least one survey was associated with 27% and 46% lower odds (p < 0.00) when patients' preferred language is Spanish and 'Other', respectively, compared to English. 

CONCLUSIONS: A SDoH screen was successfully integrated into ambulatory cancer care allowing for systematic referrals to relevant resources. Future research can incorporate clinician and patient perspectives and examine the impact of subsequent SDoH related interventions on patient outcomes.