Whole-person health models are revolutionizing healthcare by emphasizing a comprehensive approach that extends beyond disease and physical symptoms. This thesis, rooted in the Integrated Conceptual Framework for Understanding and Addressing Social Determinants to Advance Cancer Health Equity from the American Cancer Society (ACS), provides a cohesive body of work that recognizes non-biological factors in cancer care, reflecting pervasive inequities which impact health. First, a narrative review explored the literature related to tracking non-medical aspects of care in the electronic health record (EHR). Themes from this review focused on social care and informed the second paper, which focused on health-related social needs (HRSNs) screening tools for integration into standard oncology practice. These papers highlighted gaps in the extant literature including the intricate interplay of non-medical factors which extend disparities in health care access and quality, ultimately widening the gap in cancer outcomes. Targeted screening may have unintended consequences in exacerbating inequities. Therefore, the goal of the original two-stage research design was to explore HRSN screening completion in sub-populations and the impact of risk on supportive oncology care delivery, as well as inform the development of equitable implementation strategies.

In Aim 1, cancer patients in active treatment from April – June 2024 (N = 2,375) were included in an EHR report to examine associations between race, primary language, and primary insurance on HRSN screening completion with the Health Leads tool across four domains: transportation access, food insecurity, housing instability, and financial resource strain (Health Leads, Inc., 2018). Identified risk in these domains were also analyzed to understand impact on supportive oncology care delivery. A patient's primary language was found to be a significant determinant of both HRSN screening completion and engagement with supportive oncology care. Patients who screened positive for high-risk needs were at least two times more likely to have subsequent encounters with the supportive oncology care team. Conversely, patients whose primary language was not English had a statistically significant 15-16% lower incidence rate of receiving supportive oncology care. Lastly, in Aim 2, oncology social workers, patient navigators, and nurse navigators (N = 31), who regularly conducted HRSN screening, completed a survey to interpret the results of Aim 1 and explore strategies to increase screening completion among non-English speaking cancer patients. This research resulted in actionable recommendations to refine the HRSN screening process at a multi-site cancer center; the involvement of interpreters and additional translated materials were suggested as effective strategies to reach diverse patients.

This study identified key barriers to HRSN screening and supportive oncology care. The research provided critical insights that will be used to develop targeted interventions, ultimately improving access and addressing the most significant HRSNs for diverse patient groups.