MOQC and the Patient Advocate Foundation (PAF) teamed up on a patient-centered project to improve how unmet non-medical needs are identified and addressed in cancer care. While it’s well known that social factors like transportation, housing, and financial insecurity play a big role in health outcomes, most existing screening tools weren’t created with direct input from patients. That is something this project is working to change.
Using a collaborative, patient- and research-informed approach, MOQC and PAF are exploring how non-medical needs affect workflows in oncology practices and how they impact patient experiences. The goal is to find better ways to support patients’ needs without adding extra strain on staff or systems.
For this initiative, MOQC partnered with three oncology practices in Michigan: MyMichigan Sault in Sault Ste. Marie, West Michigan Cancer Center in Kalamazoo, and Bronson Cancer Center in Kalamazoo and Battle Creek. In early 2025, a team from MOQC and POQC visited these sites and interviewed 42 staff members ranging from oncologists and social workers to nurse navigators and dietitians. Staff at all three sites were welcoming, open, and incredibly generous with their time and insights.
All practices had processes in place to regularly assess unmet non-medical needs, including using the National Comprehensive Cancer Network (NCCN) distress screening tool, a screening tool specifically for breast biopsy patients, or a detailed transportation assessment to evaluate transportation needs. Transportation stood out as the most common need, followed by housing and financial insecurity.
While many of the challenges were shared, like limited resources, staff discomfort discussing sensitive topics, and stigma around needing help, some were unique to each site, such as location-specific issues or lack of dedicated social workers. Importantly, none of the staff viewed non-medical needs screenings as a burden or time drain. In fact, all three practices showed a strong commitment to addressing these needs and improving care for both patients and caregivers.
Looking ahead, the next phase of the project will focus on hearing directly from patients. A nationwide survey, shaped with feedback from POQC, is being developed and shared with patients to better understand their perspectives. Data from both staff interviews and patient surveys will be analyzed by PAF, with reviews by MOQC and Gilead. The findings will help guide future work, including conference presentations and a demonstration project that aims to refine unmet non-medical needs workflows and test improvements in select practices.
By combining real-world insights from providers, patients, and caregivers, this project is paving the way for a more person-centered and compassionate approach to cancer care.