Enhancing clinical access to supportive oncology for underserved patients.

106 Background: Supportive Oncology (SO) at Dana-Farber Cancer Institute (DFCI) include Social Work, Psychiatry, Psychology, and Palliative Care. These services enhance goal-concordant care and overall well-being for oncology patients; however, there may be barriers to accessing this care particularly for those impacted by structural inequities. From January 2024 to May 2024, the average combined cancellation/no-show rates to new SO consult appointments was higher in patients from historically marginalized communities and with Medicaid-type primary insurance plans than the general population (39% compared to 25%). Baseline assessment revealed many of these patients were unclear why they were referred to SO and faced additional resource barriers. Methods: We conducted feedback sessions with patients, caregivers, and clinical staff to identify SO access challenges. We then piloted a process involving outreach calls. As we collected data, we iterated the process over a series of PDSA cycles. The primary goal of outreach was to provide education about SO services and their role in enhancing cancer care. Secondary goals included: 1) offering patients another pathway to identify challenges to care access; 2) offering resources to address challenges. The target patient population included new SO patients from historically marginalized communities and/or with Medicaid insurance plans. To evaluate effectiveness of this outreach process, cancellation and no-show rates to initial SO consult appointments were measured. Results: We identified key issues impeding access to SO based on patient, caregiver, and staff feedback: lack of understanding of SO services and resource barriers, including inconsistent transportation. Outreach was attempted with 92% of patients who met criteria; 78% of these patients engaged in education and assessment. Other measures included: referrals to additional supportive care services within DFCI (64% of patients), education about community resources, and outreach to primary oncology teams to facilitate communication with patients (16% of patients). After initiation of the intervention, cancellation/no-show rates dropped from 39% to 24%, mirroring average rates of the overall SO patient population. Conclusions: 1) Most patients/caregivers reported it was helpful to review the role of SO and share their own expectations ahead of their SO consult appointment. 2) Outreach with general screening questions offers patients an additional pathway to identify support issues, enhances linkages to services that support patients, accounts for changing situations, and enhances patient-centered care within SO. Further opportunities: 1) Further examination of language preferences impacting outreach and assessment and outcomes is needed; and 2) Developing targeted interventions to assist in bridging some gaps in community resource support is necessary for patients/families to engage in clinical care.