e23181 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 worse health outcomes. Although increasingly recognized as key to quality care delivery, HRSN screening may be challenging in low-resource community oncology settings. In this study (WF-2303CD), we sought to understand HRSN screening implementation in a national sample of clinics in the NCI Community Oncology Research Program (NCORP). Methods: This mixed methods observational study was conducted with the Wake Forest NCORP Research Base. We trained site staff to assess current HRSN screening processes and contextual factors influencing implementation using Context-Driven Co-Design methods, 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 to inform clinic classification based on HRSN screening implementation quality and comprehensiveness. Results: We assessed HRSN screening processes and factors influencing implementation in 41outpatient oncology clinics across 18 NCORP Community Sites. Preliminary results suggest wide implementation variation in the 37 clinics that self-reported HRSN screening. Most clinics reported using the NCCN Distress Thermometer (n = 16) or Epic SDOH Wheel (n = 9), while others relied on verbal screening or non-validated homegrown tools (n = 12). Further evaluation revealed few clinics had high-quality, systematic screening processes and even fewer had robust processes for following up on reported needs or needs reassessment. Identified implementation challenges included reliance on staff assumptions or patients raising concerns unprompted, processes reaching only a subset of patients (e.g., patients receiving infusions), or only focused on specific HRSN domain(s). Contextual factors identified as influencing HRSN screening are highlighted in Table 1. Conclusions: This is the first national, in-depth study of HRSN screening in community oncology settings. Findings illuminate the current capacity of diverse clinics to identify patients with unmet HRSN, screening tools and approaches in use, implementation gaps, and potential levers of change. These insights will inform future efforts to enhance HRSN screening in oncology. Contextual factors influencing HRSN screening implementation. Facilitators Barriers Leadership investment Accreditation process Staff perceptions of importance Integration of social work/navigation with primary care team Trust (patient-staff, staff-staff) Staff turnover Staff time constraints Need for multiple workflows to reach all patients Lack of awareness of community resources Challenges accessing HRSN responses from other settings
Haines et al. (Thu,) studied this question.