A new report from the Social Interventions Research and Evaluation Network (SIREN) at the University of California San Francisco identified several knowledge gaps that should be addressed to inform efforts to implement and scale up social screening practices in the U.S. healthcare system.
Emilia H. De Marchis, M.D., M.A.S., an assistant professor in the Department of Family & Community Medicine at UCSF, is the lead author on “State of the Science of Screening in Healthcare Settings, which was supported by the Robert Wood Johnson Foundation.
The report examined and synthesized the existing literature on social screening in healthcare settings and noted that while there has been quite a bit of research done, “it is not yet impressively rigorous. Many of the studies on social screening are qualitative, include small sample sizes, and/or lack comparison groups."
For instance, when it comes to the basic question of how many people are getting screened, the authors say “we know relatively little about the prevalence of social screening across U.S. healthcare settings and there is not yet a clear strategy for improving national prevalence estimates. Without these, it will be difficult to understand the impacts of investments intended to increase screening. Future prevalence assessments will need to address the lack of both shared prevalence measures and denominator reporting.”
Patient perspectives on screening: The authors note that although research suggests that patients and patient caregivers generally find social screening to be acceptable, “relatively little research has explored or compared the perspectives of racially, ethnically, and linguistically diverse patient populations.” They added that several studies surface patients’ concerns about the collection/ storage/sharing of social data.
Healthcare team perspectives on screening: Research tends to support the idea that healthcare professionals generally believe activities related to patients’ social needs are within the scope of practice of healthcare and can strengthen relationships with patients, the authors note. “Education/training and screening program participation help to reduce many provider concerns about implementing social screening, with the exception of concerns about clinic workflow and the availability of social services.”
Implementation best practices: The authors find that in the published literature to date, there are no consistently reported differences in screening reach by race/ethnicity, although two studies found lower reach in Spanish-language speaking patients. Few studies have rigorously examined differences across studies on screening disclosure by factors such as healthcare setting, workforce conducting screening, framing for screening, modality of screening (in-person interview, telehealth interview, tablet [including chatbot]). Telehealth did not substantively decrease screening reach.
The authors expressed hope that surfacing the literature gaps will prompt a commitment to learning more about social screening and social care interventions in coming years. “The ‘thousand flowers blooming’ approach that has heretofore characterized screening approaches, including around tool selection, workforce, and modality for screening, presents us with myriad opportunities to learn about what works and for whom,” they wrote. “As those opportunities continue expanding, it is incumbent on healthcare stakeholders to learn from them, ensure they involve relevant data collection (including on race, ethnicity, and language of participants), invest in data analysis, and finally, share findings.”
