Formative evaluation on promoting social risk screening among cancer patients in Kaiser Permanente Southern California

health practitioners require further guidance to ensure effective screening and avoid potential harm.Objective: Identify the impact of transportation insecurity across the transplant cascade (referral, evaluation, wait listing, activation, and transplant) and opportunities to utilize social risk screening and interventions to improve access and equity to kidney transplantation without causing harm.Methods: Qualitative interviews with 49 patients with endstage kidney disease (ESKD) treated with in-center hemodialysis and 29 dialysis staff focused on the role of social risk on kidney health.Results: Patients with ESKD treated with in-center hemodialysis face layered social risk.Existing systems and staff within dialysis centers lack training and skills to robustly identify and address these risks.As a result, patients facing social risk are not viewed as "good" transplant candidates, creating a cycle of limited access to kidney transplantation for these individuals.Conclusion: Without training and support to screen and address social risks in the ESKD population, health policy decisions promoting social risk screening may exacerbate inequities.Coordinated efforts are needed to better target screening and develop interventions that ethically collect social risk data to support patients to gain comprehensive kidney care.