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Prevalence of Financial Hardship and Health-Related Social Needs in Pediatric Oncology: A Practice-Level Analysis of
Melissa P Beauchemin1,2, Kathryn Henschel3, David DeStephano2
1School of Nursing, Columbia University Irving Medical Center, New York, New York, USA.
Insights
Systematic screening for financial hardship and health-related social needs (HRSN) in pediatric oncology is feasible. This approach identifies at-risk families, enabling timely interventions to improve patient outcomes.
Area of Science:
- Pediatric Oncology
- Health Services Research
- Social Determinants of Health
Background:
- Screening for financial hardship and health-related social needs (HRSN) is recommended in pediatric oncology.
- Current practices vary, with limited standardized implementation.
- A systematic screening was implemented in a New York City pediatric oncology clinic.
Purpose of the Study:
- To evaluate the implementation of financial hardship and HRSN screening in a pediatric oncology outpatient clinic.
- To analyze response rates and determine the prevalence of financial hardship and HRSN.
- To assess the feasibility of a multipronged screening approach.
Main Methods:
- Evaluated financial hardship (2 items) and HRSN (8 items) screening.
- Utilized in-person screening by social work teams and direct-to-patient EHR portal screening.
- Extracted data from EHR for patients ≤18 years over a 2-year period.
Main Results:
- 76% of 621 pediatric oncology patients responded to screening.
- Hispanic and non-Hispanic Black patients had higher response rates.
- 21% reported food insecurity; 76% reported financial hardship, with higher rates in Hispanic and non-Hispanic Black patients.
Conclusions:
- Systematic screening for financial hardship and HRSN in pediatric oncology is feasible via a multipronged approach.
- Screening is crucial for early identification of at-risk families.
- Timely interventions can prevent financial crises and improve patient/household outcomes.
Background:
Screening for financial hardship and health-related social needs (HRSN) in pediatric oncology is recommended, yet practices vary widely, and standardized implementation remains limited. We implemented systematic screening in a pediatric oncology clinic in New York City.
Procedure:
We evaluated the implementation of financial hardship (two items) and HRSN (difficulty affording food, housing, transportation, eight items) screening in outpatient pediatric oncology clinic. Screening strategies included in-person screening by social work teams during inpatient or emergency department visits, and direct-to-patient screening via the electronic health record (EHR) patient portal for patients or caregivers who utilized the portal to check in for upcoming encounters. Data were extracted from the EHR of patients ≤18 years treated in the outpatient oncology clinic over a 2-year period. We analyzed response rates and calculated the prevalence of financial hardship and HRSN.
Results:
Among 621 pediatric oncology patients, 76% responded to screening, with Hispanic and non-Hispanic Black patients more likely to respond than non-Hispanic White patients. Among those who responded, 21% reported food insecurity, with significantly higher rates among Hispanic (35%) and non-Hispanic Black (24%) patients compared with non-Hispanic White (6%) and Asian (7%) patients. Financial hardship was reported by 76%, with higher rates among patients who were Hispanic (87%), non-Hispanic Black (87%), and Spanish-speaking (97%).
Conclusions:
Systematic screening for financial hardship and HRSN in pediatric oncology is feasible using a multipronged approach. Screening is crucial to early identification of at-risk families in order to implement timely interventions to prevent catastrophic financial situations and, potentially, to improve patient and household outcomes.
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