JMIR Publications

ABSTRACT

Background:

Social determinants of health (SDOH) such as lack of basic resources, housing, transportation, and social isolation play an important role for patients on the cancer care continuum. Health systems’ current technology solutions for identifying and managing patients’ SDOH data largely focus on information recorded in the electronic health record by providers, which is often inaccessible to patients to contribute to or modify.

Objective:

In response, we developed and tested a patient-centric SDOH screening tool for a patient’s personal mobile phone that preserves patient privacy and confidentiality and collects information on cancer patients’ unmet social needs and communicates that to the provider.

Methods:

We interviewed 22 cancer patients, oncologists, and social workers associated with one US-based comprehensive cancer center to better understand how patients’ SDOH information is collected and reported. After triangulating data from thematic analysis of interviews, an environmental scan, and a literature search of validated tools to collect SDOH data, we developed a SDOH screening tool mobile application and conducted a pilot study of 16 dyadic pairs of patients and cancer care team members in the same cancer center. We collected patient SDOH data using 36 survey items covering seven SDOH domains and used validated scales and follow-up interviews to assess the app’s usability and acceptability among patients and cancer care team members.

Results:

Formative interviews with patients and care team members revealed that transportation, financial challenges, food insecurity, and low health literacy were common SDOH challenges; and that a mobile app that collected those data, shared those data with care team members, and offered supportive resources, could be useful and valuable. In the pilot study, 25% of app-using patients reported having at least one of these social needs; the most common social need was social isolation (44%). Patients rated the mobile app as easy to use, accurately capturing their SDOH, and preserving their privacy, but suggested the app could be more helpful by connecting patients to actual resources. Providers reported high acceptability and usability of the app.

Conclusions:

Use of a brief patient-centric mobile app-based SDOH screening tool can effectively capture cancer patient SDOH for care team members in a way that preserves patient privacy and that is acceptable and usable for patients and care team members. However, only collecting SDOH information is not sufficient; usefulness can be increased by connecting patients directly to resources to address their unmet social needs