Isabelle Franklin, medical student, Kaiser Permanente Bernard J. Tyson School of Medicine, discusses strategies healthcare providers can implement to address or ameliorate disparities in place that are affecting screening rates in colorectal cancer (CRC).

the effect of social determinants of health on CRC screening rates

at Kaiser Permanente were presented at the 2023 ASCO Annual Meeting. Of the 3,443 patients who completed the Kaiser Permanente National Social Needs Survey in 2020, a significant correlation between unmet self-reported social needs and lower rates of screening was identified. These self-reported social needs included severe financial strain, feelings of social isolation, and food insecurity. Moreover, patients who were advanced in age, who were not insured, and those whose primary language was not English had lower CRC screening rates, indicating the correlation between demographic factors and CRC screening completion.

These findings indicate the importance of investing in social and hospital-led programs to mitigate barriers to screening completion in CRC. To do so, it is first necessary to obtain information on a patient's potential disparities early on, Franklin states. This can be done through intake screening survey when patients arrive at the clinic, or by requiring providers to ask their patients about any challenges accessing care during the visit, Franklin suggests.

Once a patient's needs have been identified, providers should implement measures, identify local organizations, and share appropriate resources to help patients meet their basic needs, Franklin continues. At Kaiser Permanente, the pilot program, Thrive Local, has been developed to help providers ensure their patients' have knowledge of and access to community resources and organizations, Franklin details. Thrive Local involves the use of a database containing this information that can be filtered by type of social need and by a patient's zip code, she explains. Furthermore, its integration with patients' electronic health records allows providers to directly refer their patients to these organizations using the patient portal. This allows providers to receive real-time confirmation that their patients have connected with the recommended resources, Franklin concludes.

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Isabelle Franklin, discusses strategies healthcare providers can implement to address or ameliorate disparities in place that are affecting screening rates in colorectal cancer.


Franklin on Strategies to Ameliorate the Effect of Social Determinants on CRC Screening Rates

Isabelle Franklin, medical student, Kaiser Permanente Bernard J. Tyson School of Medicine, discusses future steps to be taken following an investigation into the association between self-reported social needs and colorectal cancer (CRC) screening rates.

investigators shared data in a poster presentation from a cross-sectional study

 evaluating 3,443 patients. These patients were between the ages of 50 and 75 years, were in the Kaiser Permanente Health System, and had also completed the Kaiser Permanente National Social Needs Survey in 2020. Notably, the investigation revealed that patients who reported severe financial strain (26%), severe social isolation (24%), or severe food insecurity (29%) were more likely to not undergo CRC screening than patients who did not report severe financial strain (17%; 

 =.011), or severe food insecurity (18%; 

Additionally, the investigators noted that 25% of patients who reported severe housing instability and 35% of patients with severe transportation issues were less likely to undergo CRC screening compared with patients who did not report severe housing instability (18%; 

Looking to the future of this research, Franklin details that she has been collaborating with quality improvement leaders within each of the Kaiser Permanente regions since the initiation of this project. Moreover, the study investigators are now in the process of meeting with each of these regional quality improvement leaders to share region-specific data with them, Franklin explains. The hope is that these leaders will take these results back to their teams to inform quality improvement initiatives and increase CRC screening rates, she emphasizes.

On a larger scale, this type of research reinforces the importance of screening for social needs and encourages, at a systemic level, investing in programs that leverage community organizations, Franklin expands. These actions connect patients with the resources they need, she concludes.

Isabelle Franklin, discusses future steps to be taken following an investigation into the association between self-reported social needs and colorectal cancer screening rates.


Franklin on Future Steps for Investigating the Association Between Social Needs and CRC Screening Rates

Isabelle Franklin, medical student, Kaiser Permanente Bernard J. Tyson School of Medicine, discusses the correlation between self-reported social needs and colorectal cancer (CRC) screening.

In a cross-sectional study presented at the 2023 ASCO Annual Meeting, investigators evaluated 3,443 patients between 50 and 75 years of age from Kaiser Permanente who completed the Kaiser Permanente National Social Needs Survey in 2020. Data from the investigation showed that patients with financial strain well and social isolation were more likely to not undergo screening.

This investigation looked at patients’ self-reported social needs, including financial strain, housing instability, transportation issues, social isolation, and food insecurity, all within the Kaiser Permanente patient population, Franklin begins. Notably, CRC is one of the leading causes of cancer death in the United States. However, consistently lower rates of CRC screenings have been reported compared with those for breast or cervical cancer, Franklin explains. Many studies have been previously conducted to identify driving factors behind these lower screening rates, as have several large systematic reviews of patient-reported barriers to CRC screenings, Franklin adds. Based on this research, social determinants of health have emerged as some of the principal driving factors behind low screening rates.

Due to the modifiable nature of social determinants of health, these are an ideal target for quality improvement-focused research, Franklin expands. However,although these patient-reported barriers have previously been described, few studies have analyzed how these barriers and social needs affect screening rates, such as those for CRC, she notes.

This unique dataset from Kaiser Permanente is due to the robust electronic health record, granting investigators access to a large amount of data. Due to this large amount of data, investigators were able to link those patient-reported survey data to their electronic medical record screening status, providing a clearer picture of what patient-reported needs and social needs are linked to lower screening rates, Franklin explains. The goal of this research is to inform future quality improvement efforts within the Kaiser Permanente region, resulting in improved cancer screening rates, Franklin concludes.

Isabelle Franklin, discusses the investigation of the correlation between self-reported social needs and colorectal cancer screening.


Franklin on the Investigation of Social Needs and Screening Rates in CRC

Isabelle Franklin, medical student, Kaiser Permanente Bernard J. Tyson School of Medicine, discusses the effects of social determinants of health on rates of colorectal cancer (CRC) screening.

At the 2023 ASCO Annual Meeting, investigators presented data from a cross-sectional study of 3,443 patients between 50 and 74 years of age, from Kaiser Permanente who completed the Kaiser Permanente National Social Needs Survey in 2020. When overlaying social needs and screening completion data, a significant correlation was found between 3 of 5 social needs and lower rates of screening, Franklin begins. Data showed that patients with financial strain were more likely to not undergo screening (26%) compared with those without sever financial strain (17%; 

 < .001). Additionally, those who reported social isolation were less likely to be screened (24%) vs those who did not (18%; 

 =.011), and patients who reported severe food insecurity were more likely to not be screened (24%) vs those without severe food insecurity (18%; 

 = .005). Notably, 25% of patients who reported severe housing instability did not receive CRC screening vs 18% of patients without severe housing instability (P = .005), and 35% of patients with severe transportation issues did not undergo screening compared with 18% of patients without transportation issues (

 = .003). That data from housing instability and transportation issues bordered on statistical significance, Franklin says.

The study included data from patients across all regions within Kaiser Permanente health-care system, Franklin continues. Moreover, each of the 7 regions that were evaluated had slightly different individual results regarding which of the 5 social needs were significant when they were examined in isolation, Franklin adds. For example, although correlative data for transportation and housing issues were not statistically significant for the overall study, they were significant when looked at in some regions specifically, she says. Therefore, it is important to understand that all these social needs could potentially play a role in CRC screening rates, and each of them could represent an area to address to improve rates of screening, Franklin emphasizes.

Franklin notes that since these results were taken from patients within the Kaiser Permanente health-care system, all patients were insured. Although the assumption could be that having health insurance negates problems associated with screening rates and other issues, disparities can still persist for these patients, Franklin concludes.

Isabelle Franklin discusses the effects of social determinants of health on rates of colorectal cancer screening.


Isabelle Franklin

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Franklin on Strategies to Ameliorate the Effect of Social Determinants on CRC Screening Rates

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