Social needs screening in hepatology clinic: A qualitative study of patient experience

Background: People with chronic liver disease (CLD) and health-related social needs (HRSN) experience poor health outcomes. Therefore, screening for and reducing HRSN in liver clinics may lead to improved CLD-related outcomes. The objective of this study is to assess patient perspective and acceptability of HRSN screening conducted in liver clinic among those with CLD.

Methods: This is a qualitative study conducted using semi-structured interviews from November 2023 to June 2024. Patients with CLD were recruited from liver clinic. Purposive sampling ensured diversity by self-reported HRSN. A previously published interview guide, adapted for this study, was used to assess participants’ perception of HRSN screening. Interviews were conducted virtually in English and audio recorded. Participants were given $50, and interviews were collected, recorded, and transcribed verbatim. Data were analyzed using Crabtree & Miller’s approach creating codes and identifying themes through “open coding”, a process of developing codes for salient concepts as they emerge iteratively during the analysis process.

Results: Fifteen interviews were conducted. Among them, 87% of interviewees were women, the mean age was 57 years old, 67% were Non-Hispanic White, 20% were Hispanic, and 13% were American Indian/Alaska Native; 53% had cirrhosis. HRSN were prevalent: 20% with food insecurity, 53% with financial strain, 13% with financial needs, and 20% with housing instability. Interviews ranged from 9 to 63 min (average time of 25 min). HRSN screening was reported to be acceptable; interviewees felt comfortable or neutral answering questions. Most participants indicated close associations with health and HRSN like stress, transportation needs, financial strain, and social isolation. One patient reported losing their social circle to maintain sobriety as advised. Some expressed a desire for providers to offer referrals to resources. Specifically, participants requested assistance with transportation, finding more affordable medications, and strategies to cope with alcohol use triggers (e.g., isolation or stress).

Conclusions: HRSN screening in liver clinic is pertinent for the CLD patient population. The patient perspective demonstrates that liver clinics provide an invaluable opportunity to help address HRSN.