Patients’ Comfort with Clinicians Sharing Information About Social Determinants of Heath: Findings from the Health Information National Trends Survey

INTRODUCTION

With the rise of value-based care in the USA, screening for social determinants of health (SDH) may create opportunities for social care, including assisting with social needs via referral resources, and increased patient engagement via tailoring medical care based on patients’ social circumstances.¹ A key step towards facilitating social care includes ensuring that SDH information is captured in the EHR and accessible to the healthcare team.² However, patients’ decisions to share SDH information with clinicians may be based on trust in clinicians and the healthcare system, as well as systemic injustices and discrimination. For instance, prior work demonstrates a significantly higher likelihood of non-disclosure amongst patients who experienced discrimination and those with low trust.³ However, little is known about when patients are comfortable with their physician sharing their SDH information, which may be perceived as outside of the scope of healthcare.⁴ The objective of this study was to determine how patients’ trust in healthcare and socio-demographic characteristics may be related to their comfort with clinicians sharing SDH information with other clinicians for treatment purposes.

METHODS

We performed a secondary data analysis of the National Cancer Institute’s nationally representative 2022 Health Information National Trends Survey (HINTS) 6, administered to 6252 US adults between March and November 2022. Our final sample included 5161 patients with complete data for all included variables. HINTS 6 measured whether patients had three types of social needs: food, housing, or transportation insecurity, and whether patients would feel comfortable their clinicians sharing SDH information with other clinicians for treatment purposes. The outcome was patient comfort with clinicians sharing SDH information, measured as an ordinal variable summing the number of SDH in which a patient would feel somewhat or very comfortable with their clinician sharing (range = 0–3). For example, a patient reporting feeling comfort with their clinician sharing information about food and transportation access, but not housing, would receive a score of 2.

We estimated a survey-weighted multivariable ordinal logistic regression model to investigate the relationship between comfort with clinicians sharing SDH information with other clinicians for treatment purposes and several factors, including patient trust in the healthcare system (measured as “a lot,” “some,” or “a little or not at all”), number of social needs, age, gender, race/ethnicity, education, insurance, location, number of physical conditions, and depression.

RESULTS

Most patients reported having some (46.58%) or a lot (36.59%) of trust in the healthcare system (Table 1). Patients’ level of trust in healthcare was significantly related to comfort sharing SDH information (chi² p-value < 0.001). Patients who reported having a lot of trust in the healthcare system were more likely to feel comfortable sharing SDH information with other clinicians for treatment purposes relative to those with little or no trust in the healthcare system (36.59% vs. 16.83%, OR: 1.34, 95% CI: 1.03–1.74, Table 2). Patients with two or more physical diagnoses had lower odds of feeling comfortable sharing SDH information relative to those with no diagnoses (OR: 0.75, 95% CI: 0.58–0.98).

Table 1.

Patient Characteristics (n = 5161)

	Survey-weighted %	Raw N
Trust in healthcare system
A little or not at all	16.83	744
Some	46.58	2409
A lot	36.59	2008
Social risk factors
0	78.83	4137
1	10.39	566
2	6.09	259
3	4.69	199
Age
18–29	17.71	453
30–44	24.91	1085
45–59	28.95	1271
60 +	28.43	2352
Gender
Male	49.29	2065
Female	50.71	3096
Race/ethnicity
White non-Hispanic	61.97	2987
Black	11.12	812
Hispanic	16.61	917
Asian or other non-Hispanic	10.30	445
Education
Less than high school	6.29	296
12 years or completed high school	21.03	897
Some college	39.21	1489
College graduate or higher	33.47	2479
Insured
No	10.66	420
Yes	89.34	4741
Locationa
Metropolitan	86.59	4462
Micropolitan	7.40	407
Small town	3.73	188
Rural	2.29	104
Physical diagnosesb
0	51.34	2155
1	27.66	1603
2 +	20.99	1403
Depression diagnosis
No	71.43	3753
Yes	28.57	1408

^aLocation categories are derived from USDA Primary Rural–Urban Commuting Area (RUCA) codes 2010, as provided by HINTS 6 (please refer to https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/documentation/ for more information)

^bPhysical. pressure, and lung disease

Table 2.

Odds Ratios of Patient Comfort with Clinicians Sharing SDH Information with Other Clinicians for Treatment Purposes, Adjusting for Demographic Factors, Social Needs, and Health Conditions (n = 5161)

	Comfort with clinicians sharing SDH information with other clinicians for treatment purposes Odds ratio (OR)	95% CI	p-value
Trust in healthcare system
A little or not at all	ref		ref
Some	1.09	(0.83, 1.43)	0.531
A lot	1.34	(1.03, 1.74)	0.028
Social risk factors
0	ref		ref
1	0.82	(0.62, 1.08)	0.147
2	0.95	(0.59, 1.51)	0.809
3	0.98	(0.54, 1.78)	0.951
Age
18–29	ref		ref
30–44	1.17	(0.78, 1.77)	0.439
45–59	1.00	(0.65, 1.55)	0.997
60 +	1.33	(0.92, 1.92)	0.127
Gender
Male	ref		ref
Female	1.04	(0.85, 1.26)	0.720
Race/ethnicity
White non-Hispanic	ref		ref
Black	1.18	(0.91, 1.53)	0.216
Hispanic	1.10	(0.82, 1.47)	0.537
Asian or other non-Hispanic	1.06	(0.73, 1.52)	0.769
Education
Less than high school	ref		ref
12 years or completed high school	1.07	(0.64, 1.79)	0.800
Some college	1.01	(0.60, 1.70)	0.967
College graduate or higher	1.13	(0.70, 1.84)	0.607
Insured
No	ref		ref
Yes	1.01	(0.72, 1.42)	0.946
Locationa
Metropolitan	ref		ref
Micropolitan	0.73	(0.53, 1.0)	0.049
Small town	1.42	(0.78, 2.59)	0.249
Rural	0.92	(0.41, 2.08)	0.843
Physical diagnosesb
0	ref		ref
1	0.91	(0.69, 1.19)	0.473
2 +	0.75	(0.58, 0.98)	0.036
Depression diagnosis
No	ref		ref
Yes	1.01	(0.79, 1.29)	0.956

^aLocation categories are derived from USDA Primary Rural–Urban Commuting Area (RUCA) codes 2010, as provided by HINTS 6 (please refer to https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/documentation/ for more information)

^bPhysical. pressure, and lung disease

Bold values represent p values < 0.05

DISCUSSION

Healthcare system trust may facilitate patients’ comfort with clinicians sharing SDH information for medical care. Trust building at the clinician and organizational levels is required as social care workflows may require multiple members of the healthcare team to have access to SDH information.⁵ Given the potential for bias or discrimination based on SDH information, conversations between clinicians and patients on when and why SDH information are being collected are required for building trust. Such conversations may include which assistance and adjustment actions may be taken, with whom information may be shared, and create opportunities for patients to opt-out of screening, SDH data sharing, or social care interventions.^{1, 4}

Some limitations include low reported trust, low representation of non-White groups, and limited data on patients’ perceptions of clinicians’ ability to address social needs, both of which may relate to trust. Future research should examine the role of disparities in trust and data sharing, and assess whether patients perceive clinicians as equipped to address social needs.

Trust impacts numerous patient behaviors,⁶ including withholding information from clinicians, indicating the need for further investigation of trust and patient comfort with the sharing and use of SDH information for social and medical care so that clinicians can provide fair, inclusive, and patient-centered care.⁵

Declarations:

Conflict of Interest:

The authors declare that they do not have a conflict of interest.