Insights into missing populations: Exploring characteristics of unscreened patients with cancer in psychosocial distress and social drivers of health screening in an ambulatory setting.

174 Background: Psychosocial distress is common among patients with cancer and distress screening is required for American College of Surgeons Commission on Cancer accreditation. Screenings proactively identify needs, connect patients to services, reduce distress and improve cancer outcomes. We implemented a dynamic 17-question electronic screening tool that includes: assessment for psychosocial distress, social drivers of health (SDH) and spiritual care, and evaluated differences in patient characteristics among those who did and did not complete the survey. Methods: The survey was developed through an interdisciplinary review of evidence-based questions to proactively address supportive care needs for patients. It is available in English and Spanish and sent to patients via the patient portal 7 days before the second oncology appointment with a reminder 3 days before the appointment. It was implemented across 5 Mount Sinai Health System ambulatory facilities, spanning 3 New York City boroughs between June 2022 and February 2024. We used descriptive statistics to compare demographic and clinical characteristics of patients who did and did not complete the survey. Results: A total of 11,199 patients were assigned surveys; (42%) did not complete it. Patients who did not complete the survey were more likely to be Asian and Hispanic, older age, to speak a language other than English, reside in Queens or Brooklyn, and were less likely to have Commercial insurance compared to those who completed the survey (p<0.001 for all). There was no difference in sex (p=0.93) among the groups. Conclusions: There are significant disparities in the completion rates of electronic psychosocial distress and SDH screenings among patients with cancer, revealing that certain groups are less likely to engage with the tool. Targeted strategies are needed to increase screening completion rates among these populations. Future efforts should focus on addressing language barriers, enhancing technological accessibility, and developing culturally sensitive approaches to ensure all patients benefit from these screenings so we can better identify and address the supportive care needs of all cancer patients. Characteristics of patients who did and did not complete the survey. Characteristic Did Not Complete4654 (42%) Completed6545 (58%) p-value Race <0.001 Black 978 (21) 1538 (23) Asian 642 (14) 698 (11) Unknown 225 (5) 258 (4) Other/Patient Declined 1298 (28) 1461 (22) White 1511 (32) 2590 (40) Age (mean (SD)) 64 (14) 61 (15) <0.001 Non English Language 1167 (25) 956 (15) <0.001