Administrative Supplements for the Implementation Science Centers in Cancer Control (ISC3): Advancing Health Equity through Implementation Science

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Project Summary Social determinants of health (SDOH), social risk factors, and unmet social needs have critical implications for shaping and exacerbating health and health inequities for cancer incidence, morbidity and mortality. There is a critical need for accurate and comprehensive approaches to understanding how SDOH impact the implementation of evidence-based cancer care, equitable cancer outcomes, and health equity. Reliable, widespread, and available measurement of individual-level SDOH for all patients is a critical first step in identifying those patients at greater risk for experiencing inequities and that have unmet social needs. In our Phase I ISC3 Administrative Supplement for Advancing Health Equity through Implementation Science, Wake Forest iDAPT ISC3 and Penn ISC3 collaborated to evaluate the recent deployment of an electronic health record (EHR) module called the Epic® SDOH Wheel (herein “the Wheel”). The Wheel includes 16 items (e.g., food insecurity, transportation needs, housing, financial strain) that address social risk factors and unmet social needs. Phase I was a pre-implementation study to document current rates of SDOH screening and identify gaps in delivery, to inform strategies for increasing equitable reach of SDOH screening. We found markedly low rates of adoption of SDOH screening by oncology care teams and limited reach to oncology patients. Nonetheless, our key informant interviews revealed a commitment to measuring and addressing SDOH by the oncology care teams and clinical leaders, as well as context-specific SDOH screening tools that oncology care teams used instead of the Wheel. Findings from Phase 1 inform our proposed Phase 2 implementation pilot study to increase SDOH screening in patients undergoing cancer treatment at our Centers. Specifically, in Aim 1, we will develop tailored implementation strategies for increasing reach, equity, and adoption of SDOH screening in patients with cancer across a diverse range of cancer care settings and populations through rigorous rapid assessment of oncology care teams’ setting in the proposed clinics); adaptation of existing SDOH screening tools, and identification of implementation strategies to increase timely and widespread assessment and documentation of SDOH screening in patients with cancer. In Aim 2, we will assess the impact of tailored implementation strategies on reach, equity, and adoption of SDOH screening in patients with cancer using electronic health record data. We will use semi-structured interviews to understand factors influencing reach, equity, and adoption of SDOH screening from the perspective of patients, providers and staff. We will use findings from the proposed study to develop an R01 application for a randomized controlled trial to test the effect of CD2 on SDOH screening reach, equity, and adoption and subsequent efforts to address persistent or emergent social needs with the overarching goal of optimizing patient outcomes and improving cancer health equity.