Health-related social needs screening in community oncology settings: Results from a national sample of NCORP clinics (WF-2303CD).

Abstract

509 Background: Health-related social needs (HRSN; i.e., health-harming conditions like food insecurity and housing instability) are often unaddressed among individuals with cancer, contributing to disparities in care and worse health outcomes. HRSN screening , a first step to addressing HRSN, is increasingly recognized as necessary to quality care delivery but oncology practices face barriers to screening (e.g., staff turnover, clinician time constraints, lack of resources to address needs, and patient reluctance to share information). In this study (WF-2303CD), we sought to understand HRSN screening in a sample of clinics in the National Cancer Institute Community Oncology Research Program (NCORP). Methods: This mixed methods observational study (NCT06412029) was conducted with the Wake Forest NCORP Research Base. We trained site staff to assess current HRSN screening processes and implementation using Context-Driven Co-Design, including a key informant interview and 3 hours of clinic observation per clinic. The study team analyzed interview transcripts and observation notes using template analysis and classified clinic implementation quality and consistency as “high”, “moderate”, or “low” based on reach, comprehensiveness, documentation, and follow-up. Results: Context assessments were completed for 41 outpatient oncology clinics (e.g., medical oncology, radiation oncology, disease-specific, palliative, and survivorship clinics) across 18 NCORP community sites. Clinic classifications and tools used for HRSN screening are reported in Table 1. Findings suggest wide variation in implementation even across clinics in the same practice, and multiple screening workflows within and across clinics. Screening was influenced by accreditation standards, patient-provider and provider-provider trust in facilitating resource connection, staff turnover and time constraints, and clinic staff investment in screening. Conclusions: This is the first national, in-depth study of HRSN screening in community oncology settings. Findings illuminate the current screening capacity, screening tools and approaches, implementation gaps, and potential levers of change (e.g., clinician education, electronic screening reminders, automated referrals to social work, community partnerships). These insights will inform future efforts to enhance HRSN screening in oncology. Clinical trial information: NCT06412029 . Clinic characteristics. Clinic Characteristics N=41 (%) Implementation Rating High 9 (22.0) Moderate 24 (58.5) Low 8 (19.5) Tool Used NCCN Distress Thermometer 18 (43.9) Epic SDOH Wheel 6 (14.6) Verbal screening or site-developed tool 12 (29.3) None 5 (12.2)