Do Patients Want Help Addressing Social Risks?

Abstract

Evaluations of health care-based screening programs for social risks often report that a relatively small proportion of patients screening positive for social risk factors are interested in receiving assistance from their health care teams to address them. The relatively low number of patients who desire assistance is relevant to the growing number of initiatives in US health care settings designed to collect data on and address patients' social risks. We highlight multiple studies that have found differences between positive risks screens and desire for assistance. We explore possible explanations for those differences-focusing on the fallibility of screening tools as well as patient preferences, priorities, and lived experiences-and the potential implications for health equity.

When and How Do We Need Permission to Help Patients Address Social Risk?

“…Increasing numbers of clinics, hospitals, and emergency departments are now administering social risk screening questionnaires or asking about the social, economic, and behavioral risk factors of their patients in other ways. 1,2 In their commentary in this issue, De Marchis et al (2020) describe the rapid proliferation of these efforts, supported by national recommendations from esteemed organizations, such as the National Academies of Science, Engineering and Medicine, to continue doing so. 1,3 These efforts are being undertaken to more clearly identify subsets of vulnerable patients who have social risk factors that can be addressed by health care providers through various means (eg, referrals to social service agencies, increased intensity of care management services, embedding behavioral health providers into clinics and hospitals, food pantries, enhanced child care, and transportation offerings).…”

“…1,2 In their commentary in this issue, De Marchis et al (2020) describe the rapid proliferation of these efforts, supported by national recommendations from esteemed organizations, such as the National Academies of Science, Engineering and Medicine, to continue doing so. 1,3 These efforts are being undertaken to more clearly identify subsets of vulnerable patients who have social risk factors that can be addressed by health care providers through various means (eg, referrals to social service agencies, increased intensity of care management services, embedding behavioral health providers into clinics and hospitals, food pantries, enhanced child care, and transportation offerings). In turn, these interventions to address patients' heightened social risks might result in shorter hospital stays, less frequent emergency department visits, reductions in preventable readmissions, and improved overall health of patient populations for which a system is accountable (and for whom the system is likely assuming some financial risk).…”

“…De Marchis et al (2020) shine a spotlight on an interesting paradox that is emerging in this flurry of activity: although patients are often willing to report social risks to their health care providers, many patients do not want help in addressing them. 1 Does this mean that health care systems should stop screening patients and/or defund programs designed to help patients address social risks? Well, given the irrefutable evidence about the huge impact social context has on health, any health care system leaders deciding to take this type of action would be pushing their heads further into the sand.…”

“…Instead, De Marchis et al (2020) astutely and persuasively call for more research into several aspects of this complex area, which could better inform appropriate action. 1 Research is needed to improve our screening approaches and the precision of our diagnostic capabilities and to determine the best methods for getting help to those who need it the most. 4,5 We could also be developing a more robust scientific agenda to build the evidence that supports how best to more appropriately develop and tailor our efforts.…”

Complexities in Integrating Social Risk Assessment into Health Care Delivery

“…In this issue, De Marchis et al 18 query "do patients want help addressing social risks"? This is an interesting view of social determinants of health from the perspective of patients and practices.…”