From Screening to Support: A Multi-Method Analysis of HRSN Integration in Cancer Care

Overview

This observational study aims to identify the factors that influence whether cancer patients accept or decline supportive care services after screening positive for health-related social needs (HRSNs) at the Sidney Kimmel Comprehensive Cancer Center. The study focuses on adult oncology patients who previously reported at least one HRSN-such as transportation, food, housing, or utility needs-but declined assistance when it was offered. The main questions it aims to answer are: * What factors shape cancer patients' intentions to use supportive care services for HRSNs? * Why do patients who screen positive for HRSNs choose not to accept help offered by the healthcare system? Participants will: * Complete a one-time electronic survey delivered via MyChart or email. * Optionally participate in a semi-structured Zoom interview (for a subset of 20-30 survey respondents) to explore decision-making in greater depth.

This is a cross-sectional observational study. There will be 500 participants for MyChart survey and 20 participants for semi-structured interviews. Surveys will be distributed via MyChart and email and will take about 10 minutes to complete. The main purpose of this study is to understand why SKCCC participants are not seeking support for their corresponding HRSNs from the healthcare system. The hypothesis is that a range of factors are contributing to SKCCC patients' decline of resources to address risks identified in HRSN screening potentially inclusive of mistrust of healthcare systems, perception that there are no resources to help, feelings others can use the resources more than themselves, as well as protective factors like past resiliency and resourcefulness. An examination of the initial HRSN screening data for cancer patients within this health system revealed that, in 2024, 5,727 (74.7%; n=7662) patients who were in active cancer treatment completed the HRSN screening questionnaire in four domains: transportation access, food insecurity, housing instability, and utility needs. Of these, 716 patients (12.5%) reported having a need in at least one HRSN domain. However, only 343 patients (47.9%, n = 716) wanted help from the healthcare system to address their HRSN(s). This highlights that the majority (52.1%, n = 716) of cancer patients in active treatment who have been screened for HRSN have unmet needs that could be addressed but are not being flagged as such in our healthcare system. This preliminary data sheds light on the concrete and resource needs of cancer patients, but there is not a good understanding of why participants are not seeking support for their corresponding HRSNs from the healthcare system.