Founded at the Abramson Cancer Center at the University of Pennsylvania

Optimizing Collection of Social and Behavioral Determinants of Health in Breast Cancer Care

Social and behavioral determinants of health


Social and behavioral determinants of health (SBDoH) are well-known root causes that have led to and perpetuate the disparities among patients with breast cancer. SBDoH comprise the complex socioeconomic, demographic, psychological, and environmental factors that impact patients’ health outcomes alongside clinical factors. These can include patients’ housing, access to education, literacy, employment opportunities, exposure to racism and discrimination – all of which shape a person’s life experience and consumption of healthcare. Working to address SBDoH in a holistic, scalable approaches not only positively impacts health outcomes, but improves health equity and access to care for all.

Recent years have seen an increased focus on the collection and documentation of SBDoH in the electronic health record (EHR), in part driven by an emphasis on shifting from reactive interventions to proactively redressing modifiable contributors to disparities. However, SBDoH are not systematically collected, resulting in high rates of missingness, which can be attributed to system factors including absence of a streamlined process for collecting data, clinical factors related to workflow linking patients with interventions to redress disparities, and patient factors such as discomfort discussing challenges. Several simple, validated, patient-facing tools exist that can assess distress and SBDoH but their routine incorporation into clinical care remains limited. Likewise, SBDoH data, once collected, can be difficult to apply towards patient-level interventions and analyzed for improved understanding of community-based needs.

Through a collaborative research agreement with Gilead Sciences, Inc., this innovative study proposes that early, anticipatory point-of-service screening for SBDoH – operationalized through the EHR and linked with interventions to redress disparities – will improve the equity, effectiveness, and efficiency of care for patients with breast cancer across the continuum – from screening to treatment to survivorship. A Discovery Workshop brought together an interdisciplinary team of University of Pennsylvania researchers and practitioners, community members who have survived breast cancer, and experts from Gilead Sciences, Inc., all with the goal of collaboratively identifying the patient-reported outcome measures (PROMs) for SBDoH data collection. To avoid magnifying disparities in patient access, a mixture of low- and high-tech strategies for patient engagement and data collection will be employed across 3 modalities: bi-directional conversational chatbot; MyPennMedicine patient portal; and telephone calls. The intervention will be followed by mixed-methods practice-based research to evaluate its impact and linked with interventions to address stressors.


Findings from this study will be leveraged to inform systems-focused, community-based interventions for collecting SBDoH data from all patients receiving treatment for breast cancer at Penn Medicine. Furthermore, these findings will be evaluated to guide scalable applications to SBDoH data collection more broadly in oncology and beyond.


Oluwadamilola M. Fayanju, MD, MA, MPHS, FACS; Justin Bekelman, MD; Merium Burwell; Tamara Cadet, PhD, LICSW, MPH; David Cella, PhD; Kerry Coughlin, MSW; Peter Cronholm, MD, MSCE, CAQHPM; David Dougherty, MD, MBA; Robin Evans; Laura Fluharty, MPH; Peter Gabriel, MD, MSE; Jennifer Galetta; Karen Glanz, PhD, MPH; Carmen Guerra, MD, MSCE; Ray Hess, RRT, FHIMSS, MSA; Rachel Jankowitz, MD; Jeffrey Landgraf; Julia Lewandowski; Judith Long, MD; Yehoda Martei, MD, MSCE; Anne Marie McCarthy, ScM, PhD; David Miller, MBA; Stephany Perez-Rojas, MS; Katharine Rendle, PhD, MSW, MPH; Corinne Rhodes, MD, MPH; Sharon Rivera Sanchez; Gabrielle Rocque, MD; Shoshana Rosenberg, ScD, MPH; Roy Rosin, MBA; Kathryn Ruddy, MD; Anna Schoenbaum, DNP, MS, RN-BC, FHIMSS; Heather Sheaffer, DSW, LCSW, FACHE; Larry Shulman, MD; Rosemary Thomas, MPH, CHES; Jesse Tindall, MBE, ASQ CSSYB; Richard Wender, MD; Lindsey Zinck, MSN, RN, OCN, NEA-BC 


Gilead Sciences, Inc.


Gilead Sciences, Inc.


Clinical Transformation, Health Equity

Transforming Cancer Care

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