SDOH screening can be unknowingly stigmatizing: Patient perspectives on addressing social needs in clinical settings

Background

Lack of patient engagement around the content and approach to care conversations related to social determinants of health (SDOH) can negatively impact healthcare experiences and exacerbate disparities in outcomes. Accelerating the requirement of SDOH screenings without addressing the patient-centeredness of these conversations may contribute to health inequities and yield substandard patient experiences and outcomes.

Objective

To better understand patient perspectives about language and approaches commonly used in SDOH screenings.

Methods

A mixed methods approach to gather views on stigmatizing language and terms used towards patients through a survey (N =1,205), focus groups (N =24), and virtual workshops. Participants were recruited from a diverse pool of insured patients served by PAF representing various medical diagnoses, were racially/ethnically reflective of the population, and experienced some level of healthcare access and/or affordability challenges.

Results

Experiences included four themes: screening process, patient factors, trust and communication, and insurance. Only 21% reported being “extremely comfortable” with SDOH information being recorded and available to members of their healthcare team. Judgement, embarrassment, shame, and lack of action were cited as reasons for why they were uncomfortable/dissatisfied with SDOH conversations. Finally, patients felt disclosing SDOH information would influence care offered – creating bias based on their ability to manage their medical/ non-medical financial obligations.

Conclusion

Stigmatizing language can perpetuate discriminatory attitudes, influence clinicians' decision-making when treating a patient, and affect patient trust and honesty within a care encounter. This cycle impacts quality of care and contributes to health disparities. We uncovered how, without patient engagement, language and processes the healthcare system uses everyday can feel biased and stigmatizing to those which it is designed to help. Lack of screening for SDOH can lead to negative impacts on the patient’s experience, such as financial strain, late referrals, worsening health outcomes, and personal disconnect between patient and practitioner.

Presentation slides