Expert: Oncology Teams Need Standardized Questionnaires to Discuss Social Determinants With Patients


Amelie G. Ramirez, DrPH, MPH, director of the Institute for Health Promotion Research at UT Health Science Center San Antonio, discussed the need for standardized questionnaires for clinicians to discuss social determinants of health with their oncology patients.

In an interview with Pharmacy Times at the 2023 San Antonio Breast Cancer Symposium, Amelie G. Ramirez, DrPH, MPH, director of the Institute for Health Promotion Research at UT Health Science Center San Antonio, discussed the need for standardized questionnaires for clinicians to discuss social determinants of health with their oncology patients.

View in microscopic of pathology cross section tissue ductal cell carcinoma or adenocarcinoma diagnosis by pathologist in laboratory | Image Credit: arcyto -

Q: What are the key social determinants of health that significantly impact cancer care outcomes, and what are some ways they can impact cancer care?

Amelie Ramirez: What we're finding out is your zip code may tell you a little bit more, even than your genetic code, because this is an area where you've lived, grown up and have maybe worked for a long time. And we're finding that things such as if you live in areas with high pollution, or areas that might have high poverty rates, or lower [socioeconomic status] conditions, that these things may affect your health. So, social determinants of health are everything other than medical needs. So, things such as transportation, housing instability, financial issues, as well air or food insecurity.

Q: How can health care providers address SDOH for patients with cancer?

Amelie Ramirez: We're finding now that about 50% of health issues are really related to the social needs that I've just mentioned. And so therefore, our health care providers are realizing that in order to provide the best care possible for their patients, they need to understand where their patients are coming from, so we're developing some sensitive questions that can help us give a better picture of what their patient is going through. And then working with a team of patient navigators, community health workers, and community resources, we're trying to find a way to help that patient resolve their issues. That might be dealing with food insecurity or transportation, so that the patient can truly concentrate on focusing on their health care outcomes.

Q: How can health care providers integrate SDOH information into their medication counseling for patients to support their care?

Amelie Ramirez: What we're finding is that, because of the financial toxicity of cancer, sometimes patients are not taking their medications as prescribed because they just can't afford them. So, if the providers or their health care providers can better understand, you know, what is going on and how might they help them with that—maybe finding a resource so that they can purchase more cost-effective medications, or other financial support for the individual so that they can afford their medication—it’s really important. But we’re finding that this lack of ability to sometimes pay for the medications, anywhere from 10% to 15% of our underrepresented communities are suffering with this issue. So, it's really important for our providers to try to understand that and how we can help them.

Q: How can understanding SDOH help health care providers personalize their care to patients?

Amelie Ramirez: This is a whole new area of research, but since we know that these social determinants of health might count for about 50% of the issues that are impacting our [patients] and their family’s ability to get well, providers now need to take a more proactive role. They can ask them a short series of questions to get a profile on the patient's needs, but they need to ask them in a very sensitive way because not all patients feel comfortable in answering these questions. And the other thing we're finding out is that right now, we don't have standardized questionnaires that can be utilized for these types of interviews. But most of all, employing techniques such as using motivational interviewing, just in terms of how you ask the question to get the correct information from the patient, is truly important. And then we also need the providers to do a little check-in, making sure they don't have any implicit biases that they might be projecting onto the patient because they can't afford the services or are having some type of external difficulties.

Q: How can cost influence a patient's ability to access and afford necessary cancer medications, and how can health care providers help mitigate financial barriers for those who need it?

Amelie Ramirez: This is where we're finding that financial toxicity because we know that cancer care is expensive. And so, you know, the last thing we want is for families to lose their home in order for them to try to pay for the medications and the treatments that they need for cancer. So, it really takes working together with community, it takes working together with support services that are out there that might be able to help the patient. And so, this is where the provider team needs to truly integrate the social workers within their health care system, their patient navigators, to help resolve the issue for the patient so that the patient can go and continue on their medication.

Q: How can health care providers better advocate for their patients with cancer who are struggling with care due to SDOH?

Amelie Ramirez: I think providers need to get more involved in the community and to work with our safety net organizations and to provide, you know, some adequate resources that are readily available to the patients and that are not offered as a handout, but as a primary opportunity to say, “We understand what you're going through, but here are some individuals that can help you and to make it look seamless.” So that that patient feels comfortable in truly voicing their concerns and what they can do to really concentrate on just getting better and going through their treatment.

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