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. 2024 Jul 9;24(1):783.
doi: 10.1186/s12913-024-11213-7.

Implementation of social needs screening for minoritized patients newly diagnosed with breast cancer: a mixed methods evaluation in a pragmatic patient navigation trial

Stephenie C Lemon  1 , Amy M LeClair  2 , Erika Christenson  3 , Deborah Amburgey  3 , Madyson FitzGerald  3 , Howard Cabral  4 , Chris Lloyd-Travaglini  4 , Cheryl R Clark  5 , Feng Qing Wang  2 , Joellen Ross  6 , Ellen Ohrenberger  6 , Jennifer S Haas  7 , Karen N Freund  2 , Tracy A Battaglia  3 ; TRIP Consortium [representative Tracy A. Battaglia
Collaborators, Affiliations

Implementation of social needs screening for minoritized patients newly diagnosed with breast cancer: a mixed methods evaluation in a pragmatic patient navigation trial

Stephenie C Lemon et al. BMC Health Serv Res. .

Abstract

Background: Social needs inhibit receipt of timely medical care. Social needs screening is a vital part of comprehensive cancer care, and patient navigators are well-positioned to screen for and address social needs. This mixed methods project describes social needs screening implementation in a prospective pragmatic patient navigation intervention trial for minoritized women newly diagnosed with breast cancer.

Methods: Translating Research Into Practice (TRIP) was conducted at five cancer care sites in Boston, MA from 2018 to 2022. The patient navigation intervention protocol included completion of a social needs screening survey covering 9 domains (e.g., food, transportation) within 90 days of intake. We estimated the proportion of patients who received a social needs screening within 90 days of navigation intake. A multivariable log binomial regression model estimated the adjusted rate ratios (aRR) and 95% confidence intervals (CI) of patient socio-demographic characteristics and screening delivery. Key informant interviews with navigators (n = 8) and patients (n = 21) assessed screening acceptability and factors that facilitate and impede implementation. Using a convergent, parallel mixed methods approach, findings from each data source were integrated to interpret study results.

Results: Patients' (n = 588) mean age was 59 (SD = 13); 45% were non-Hispanic Black and 27% were Hispanic. Sixty-nine percent of patients in the navigators' caseloads received social needs screening. Patients of non-Hispanic Black race/ethnicity (aRR = 1.25; 95% CI = 1.06-1.48) and those with Medicare insurance (aRR = 1.13; 95% CI = 1.04-1.23) were more likely to be screened. Screening was universally acceptable to navigators and generally acceptable to patients. Systems-based supports for improving implementation were identified.

Conclusions: Social needs screening was acceptable, yet with modest implementation. Continued systems-based efforts to integrate social needs screening in medical care are needed.

Keywords: Breast cancer; Implementation; Mixed methods; Patient navigation; Social needs.

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Conflict of interest statement

The authors declare that they have no competing interests.

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