S. Mirpuri1, S. Perez-Rojas1, K. Reddy1, C.L. Berkowitz1, E. De Jesus1, J. Lewandowski1, K. Coughlin1, A. McCarthy1, P. Gabriel1, C.E. Edmonds1, T.J. Cadet1, T. Buckingham2, V. Livingstone2, O.M. Fayanju1 1University Of Pennsylvania, Philadelphia, PA, USA 2Gilead Sciences, Inc., Foster City, CA, USA
Introduction
Social and behavioral determinants of health (SBDOH) are the conditions in which people live, work, and age, as well as their dietary and lifestyle habits. Although unmet SBDOH-related social needs can prevent treatment receipt and increase the risk of poor health outcomes, SBDOH data are not routinely captured in clinical encounters. We launched a pragmatic clinical trial, “Effect of Early Point-of-Service Social and Behavioral Determinants of Health (SBDOH) Screening and Enhanced Navigation on Care Delivery for Patients with Breast Cancer” (NCT06019988, hereafter “Breast SBDOH”) in March 2024 at our institution. Through the Breast SBDOH trial, we seek to identify the optimal combination of patient-facing data-entry platforms and validated screening instruments to capture SBDOH data among diverse patients with breast cancer using a stepped wedge cluster randomized design that compares three platforms and three instruments. Here, we report preliminary findings on sociodemographic factors associated with screening instrument completion.
Methods
Demographic data were abstracted from case report forms and the electronic health record for the first 100 eligible female patients≥18y with new diagnoses of Stage 0-III breast cancer. Patients with metastatic disease, primary language other than English, or first post-diagnosis consult scheduled<48 hours after trial referral were excluded. Chi-square, analysis of variance (ANOVA), and Kruskal-Wallis tests were used to assess differences in categorical and continuous variables.
Results
Of the first 100 trial-eligible patients (median age 59.5y), 64% were Non-Hispanic (NH) White, 26% NH Black, 5% NH Asian, and 3% Hispanic, with racial and ethnic data not available for 2%. Overall, 56 patients completed an SBDOH instrument. None of the eligible patients with less than a high school degree (6.8%, n=3) completed an instrument, while those who had completed some graduate school or more constituted the largest proportion (32.1%, n=18) of those with known education who completed an instrument (p=0.01). Of 11 trial-eligible patients with annual income<$50,000, only 27.3% (n=3) completed an instrument, but among those with incomes≥$100,000, rates of completion (62.9%) were higher than rates of non-completion (31.1%, p=0.04). There were no differences in rates of completion by race and ethnicity, marital status or insurance.
Conclusion
Although SBDOH data collection would potentially benefit patients with breast cancer at greatest risk for unmet social needs, we found that trial-eligible patients with the least education and lowest incomes were also least likely to successfully complete an SBDOH instrument, despite the high-touch, resource-rich setting of a clinical trial. Our findings suggest the ongoing need to innovate around SBDOH data collection in order to engage patients most likely to benefit from social support and services at time of diagnosis and during treatment.