Contextual Factors Relevant to Implementing Social Risk Factor Screening and Referrals in Cancer Survivorship: A...

Area of Science:

• Oncology
• Health Services Research
• Social Determinants of Health

Background:

• Social risk factors like food insecurity and transportation barriers significantly impact patient health outcomes.
• Implementation of screening and referral for social risk factors remains limited in clinical settings, especially within cancer survivorship care.

Purpose of the Study:

• To explore the current practices and challenges of screening and referring cancer patients for social risk factors within oncology settings.
• To identify barriers and facilitators for implementing systematic social risk factor interventions in cancer survivorship.

Main Methods:

• Conducted 18 qualitative, semistructured interviews with oncology teams across 3 health systems.
• Utilized the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework to guide analysis.
• Employed thematic analysis on interview transcripts to identify key themes and patterns.

Main Results:

• Participating health systems lacked standardized cancer survivorship programs and electronic health record (EHR)-based processes for identifying survivors or documenting social risks.
• Oncology teams acknowledged the impact of social risk factors but did not have systematic processes for screening or referral.
• Recommendations included designating specific staff roles, enhancing EHR data tracking, and improving community organization resource management.

Conclusions:

• Complex cancer care workflows and inadequate reimbursement hinder the ability of clinic staff to address social risk factors.
• Flexible, tailored clinical workflows and improved communication with community-based organizations are crucial for successful screening and referral program implementation.