Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA.
JNCI Cancer Spectr. 2024 Apr 30;8(3). doi: 10.1093/jncics/pkae032.
Social determinants of health and unmet social needs are directly related to cancer outcomes, from diagnosis to survivorship. If identified, unmet social needs can be addressed in oncology care by changing care plans in collaboration with patients' preferences and accounting for clinical practice guidelines (eg, reducing the frequency of appointments, switching treatment modalities) and connecting patients to resources within healthcare organizations (eg, social work support, patient navigation) and with community organizations (eg, food banks, housing assistance programs). Screening for social needs is the first step to identifying those who need additional support and is increasingly recognized as a necessary component of high-quality cancer care delivery. Despite evidence about the relationship between social needs and cancer outcomes and the abundance of screening tools, the implementation of social needs screening remains a challenge, and little is known regarding the adoption, reach, and sustainability of social needs screening in routine clinical practice. We present data on the adoption and implementation of social needs screening at two large academic cancer centers and discuss three challenges associated with implementing evidence-based social needs screening in clinical practice: (1) identifying an optimal approach for administering social needs screening in oncology care, (2) adequately addressing identified unmet needs with resources and support, and (3) coordinating social needs screening between oncology and primary care.
社会决定因素和未满足的社会需求与癌症结局直接相关,从诊断到生存。如果确定存在未满足的社会需求,可以通过与患者的偏好合作改变护理计划并考虑临床实践指南(例如,减少预约次数,改变治疗方式),以及将患者与医疗保健组织内的资源(例如,社会工作支持,患者导航)和社区组织(例如,食品银行,住房援助计划)联系起来,从而在肿瘤学护理中解决这些需求。社会需求筛查是识别需要额外支持的人的第一步,越来越被认为是高质量癌症护理提供的必要组成部分。尽管有证据表明社会需求与癌症结局之间存在关联,并且有大量的筛查工具,但社会需求筛查的实施仍然是一个挑战,对于在常规临床实践中采用、覆盖范围和可持续性方面的社会需求筛查知之甚少。我们介绍了在两个大型学术癌症中心进行社会需求筛查的采用和实施数据,并讨论了在临床实践中实施基于证据的社会需求筛查所面临的三个挑战:(1)确定在肿瘤学护理中进行社会需求筛查的最佳方法,(2)用资源和支持充分满足已确定的未满足需求,以及(3)协调肿瘤学和初级保健之间的社会需求筛查。