A Multimodal Electronic Social Determinants of Health Screening and Social Work Intervention Platform for Patients with Metastatic Breast Cancer

When a person receives a diagnosis of metastatic breast cancer, the medical focus naturally turns to the biology of the disease: the type of tumor, the drugs that might shrink it, and the schedule of treatments. Yet, a patient's ability to survive and thrive often depends on factors far outside the hospital room. These are the social determinants of health, a term that describes the conditions in which people live, work, and age. They include whether a person has enough money for food, a stable place to sleep, reliable transportation to get to appointments, and a supportive network of family or friends. For decades, researchers have known that these invisible barriers can make cancer care much harder to navigate, particularly for women from racial and ethnic minority groups who often face deeper economic hardships. The question has shifted from whether these factors matter to how best to find them and fix them before they derail a patient's treatment.

A team of researchers at Thomas Jefferson University set out to build a system to answer this question for women with metastatic breast cancer. They created a digital platform embedded directly into the hospital's electronic health records, designed to be used by oncology social workers. The goal was to screen patients for these hidden social risks using three different digital tools simultaneously and then track what help was actually provided. Between January 2022 and March 2023, the team enrolled forty-four women who were receiving treatment for metastatic breast cancer at the Sidney Kimmel Comprehensive Cancer Center. These women were mostly in their sixties, and the group included twenty-two White women and twenty women who identified as Black or Asian. The researchers wanted to see if the new system could accurately identify who needed help, whether the different tools agreed with each other, and if the help offered matched the problems found.

The process began with a conversation between each patient and an oncology social worker, conducted either by phone or video call. During these sessions, the social worker used a digital interface to ask questions about the patient's life. The system pulled from three distinct sources: a visual tool called the SDOH Wheel, which covered areas like financial strain, food security, and housing; a standardized government tool from the Centers for Medicare and Medicaid Services that asked about employment, utilities, and safety; and a custom checklist for the social worker to record specific actions they took, such as arranging financial aid or connecting a patient with a support group. The researchers then compared the answers given to these different questions to see if the tools told the same story about a patient's needs.

The results painted a clear picture of inequality. The women from racial and ethnic minority groups in the study lived in neighborhoods with significantly higher levels of economic disadvantage compared to their White counterparts. When the social workers assessed the women, those from minority backgrounds were far more likely to be flagged as at risk across almost every category, from struggling to pay bills to lacking reliable transportation. In fact, nearly all the women in the study had at least one major social risk, but the minority group carried a heavier burden, with many facing risks in five or more different areas of their lives. This confirmed that the social challenges were not evenly distributed and that the digital system successfully identified a group of patients who were navigating cancer care while facing significant external pressures.

However, the study also revealed a significant gap between identifying a problem and solving it. While the digital tools were good at spotting risks, the connection between a flagged risk and a recorded intervention was often weak. For example, many women were identified as having trouble affording food or housing, yet the medical records did not always show that a social worker had provided specific help for those exact issues. The researchers found that the different screening tools often disagreed with one another; a woman might be marked as "at risk" by one tool but "safe" by another, even when they were asking about similar topics. This lack of agreement suggests that there is no single perfect way to measure these complex social needs, and relying on just one method might miss the mark.

Perhaps the most striking finding was that the system sometimes triggered help for patients who were not officially flagged as at risk. About one-third of the women received an intervention in a category where the screening tools said they were fine. This suggests that the social workers were listening to the patients' stories and noticing needs that the rigid digital questions missed. It also highlights that human judgment remains essential, as the tools alone cannot capture the full complexity of a person's life. The study did not find major differences in how long it took to start treatment between the racial groups, but it did note that minority patients were more likely to experience interruptions in their therapy and were less likely to have their genetic testing results known. They were also more likely to have met with palliative care teams, which provide support for symptom management and quality of life.

The researchers concluded that while a multimodal digital platform can successfully map the landscape of social needs for patients with metastatic breast cancer, it is not yet a complete solution. The tools helped uncover that minority patients face a heavier load of social challenges, but the system struggled to consistently link those findings to the right actions. The study suggests that to truly support these patients, healthcare systems need better ways to standardize how they ask these questions and how they record the help they provide. Until then, the human element of the social worker remains the most critical part of the process, bridging the gap between a digital alert and the real-world support a patient needs to continue their fight against cancer.