xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT06019988</url>
    </required_header>
    <id_info>
      <org_study_id>19122</org_study_id>
      <nct_id>NCT06019988</nct_id>
    </id_info>
    <brief_title>Effect of Early Point-of-Service Social and Behavioral Determinants of Health (SBDOH) Screening and Enhanced Navigation on Care Delivery for Patients With Breast Cancer</brief_title>
    <acronym>Breast SBDOH</acronym>
    <official_title>Effect of Early Point-of-Service Social and Behavioral Determinants of Health (SBDOH) Screening and Enhanced Navigation on Care Delivery for Patients With Breast Cancer</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Abramson Cancer Center at Penn Medicine</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
      <collaborator>
        <agency>Gilead Sciences</agency>
        <agency_class>Industry</agency_class>
      </collaborator>
    </sponsors>
    <source>Abramson Cancer Center at Penn Medicine</source>
    <oversight_info>
      <has_dmc>No</has_dmc>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        The overarching goal of this project is to optimize the collection of social and behavioral&#xD;
        determinants of health (SBDOH) for patients with a pathological diagnosis of breast cancer at&#xD;
        Penn Medicine. The investigators will measure rates of SBDOH data collection by modality and&#xD;
        rates of referral to and uptake of social support services, time to evaluation, staff time,&#xD;
        acceptability, patient-centered communication, medical mistrust, and clinician acceptability.&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        The investigators will conduct a patient-level, pragmatic opt-out trial to test&#xD;
        implementation of a comprehensive, tech-enabled platform for administration of a validated&#xD;
        SBDOH screening tool in contrast to the current practice of unstructured social history&#xD;
        collection at this institution.&#xD;
  &#xD;
        For internally referred patients, study coordinators - who are functioning as patient&#xD;
        navigators - will facilitate a warm handoff from radiology to the New Patient Office as well&#xD;
        as study introduction and enrollment. If patients do not wish to have a warm handoff call&#xD;
        with a new-patient coordinator (NPC) in the NPO who will schedule the patient's consult with&#xD;
        a surgeon and/or oncologist, or if patients are diagnosed external to Penn Medicine, the&#xD;
        patient coordinator will follow up directly with the patient to facilitate communication and&#xD;
        enrollment within 24 hours of diagnosis.&#xD;
  &#xD;
        All patients who do not opt out will be part of the analytic cohort and randomized to one of&#xD;
        three screening assessment tools:&#xD;
  &#xD;
          1. Accountable Health Communities Health-Related Social Needs Screening Tool (AHC-HSRN);&#xD;
  &#xD;
          2. Health Leads Social Needs Screening Toolkit (Health Leads);&#xD;
  &#xD;
          3. National Comprehensive Cancer Network (NCCN) Distress Thermometer + Problem List (NCCN&#xD;
             DT+PL).&#xD;
  &#xD;
             . The initial request for completion will be administered via the institutional EHR's&#xD;
             Epic-based patient portal. Patients will have 48 hours to respond and will receive 2&#xD;
             reminders via a MyPennMedicine message (MPM), through which a patient can also indicate&#xD;
             a desire to opt-out if they wish.&#xD;
  &#xD;
             Patients who do not respond and remain enrolled will be randomized to either a&#xD;
             bidirectional text-based conversational agent (i.e., &quot;chatbot&quot;) or interactive voice&#xD;
             response (IVR) system administered by phone. Through the first arm, patients will engage&#xD;
             with the screening tool through an interactive two-way text messaging chatbot through&#xD;
             WaytoHealth©. Through the second arm, patients will be called over the phone and will&#xD;
             receive the screening tool through interactive voice recognition. Patients will again&#xD;
             have 48 hours to respond and will receive 2 reminders via the modality to which they&#xD;
             have been newly randomized. Patients have the opportunity to opt out through either&#xD;
             modality and discontinue study.&#xD;
  &#xD;
             Patients who have not completed the screen via any modality by the time of their first&#xD;
             surgical consult at Penn after diagnosis, will be provided the opportunity to complete&#xD;
             it electronically though a tablet at the clinic appointment. At any point, patients who&#xD;
             report challenges with particular SBDOH domains can be referred prior to initial&#xD;
             surgical consultation to Social Services at Abramson Cancer Center.&#xD;
  &#xD;
             Approximately 6 months following diagnosis and initial completion in the study trial&#xD;
             (Activity 1), a subset of patients (identified via deviant sampling) will be invited to&#xD;
             participate in semi-structured interviews (Activity 2) through which mechanisms&#xD;
             contributing to the effectiveness of the SBDOH data collection platform will be&#xD;
             evaluated. Additionally, clinicians or clinical leaders will be invited to participate&#xD;
             in semi-structured interviews.&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Not yet recruiting</overall_status>
    <start_date type="Anticipated">September 15, 2023</start_date>
    <completion_date type="Anticipated">September 14, 2024</completion_date>
    <primary_completion_date type="Anticipated">September 14, 2024</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Parallel Assignment</intervention_model>
      <intervention_model_description>All enrolled patients will initially receive one of three screening tools (The Accountable Health Communities Health-Related Social Needs Screening Tool [AHC-HRSN], Health Leads Social Screening Tool, or National Comprehensive Care Network Distress Thermometer and Problem List [NCCN DT+PL]) via the MyPennMedicine patient portal and be given 48 hours to respond. Those patients who do not respond will be randomized to one of two intervention arms, each of which is an alternative modality to receive and respond to the assigned screening tool: a bidirectional text-based conversational agent (chatbot) or interactive voice response system administered by phone.&#xD;
  There exists three instrument arms (AHC-HRSN, Health Leads, and NCCN DT+PL) and two modality arms (chatbot and IVR).</intervention_model_description>
      <primary_purpose>Screening</primary_purpose>
      <masking>None (Open Label)</masking>
    </study_design_info>
    <primary_outcome>
      <measure>Rates of SBDOH screen completion prior to initial surgical consult</measure>
      <time_frame>1 year</time_frame>
      <description>Rates of SBDOH screen completion prior to initial surgical consult will be first compared by instrument (Accountable Health Communities Health-Related Social Needs Screening Tool [AHC-HRSN], Health Leads Social Needs Screening Toolkit [Health Leads], National Comprehensive Cancer Network Distress Thermometer and Problem List [NCCN DT + PL]). Only the NCCN DT employs a 10-point Likert scale, where 0 = no distress and 10 = extreme distress. Among patients who do not respond to initial screening administration and who then receive the screening via either chatbot or IVR, rates of SBDOH screen completion will be compared by modality.</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>Time from biopsy to initial surgical consult</measure>
      <time_frame>1 years</time_frame>
      <description>Time to evaluation (TTE) will be compared first by instrument (Accountable Health Communities Health-Related Social Needs Screening Tool [AHC-HRSN], Health Leads Social Needs Screening Toolkit [Health Leads], National Comprehensive Cancer Network Distress Thermometer and Problem List [NCCN DT + PL]). Only the NCCN DT employs a 10-point Likert scale, where 0 = no distress and 10 = extreme distress. Among patients who do not respond to initial screening administration and who then receive the screening via either chatbot or IVR, rates of SBDOH screen completion will be compared by modality.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Identify factors associated with rates of post-diagnosis, pre-consultation SBDOH screen completion</measure>
      <time_frame>6 months</time_frame>
      <description>Factors associated with rates of SBDOH screen completion across all instruments (AHC-HRSN, Health Leads, and NCCN DT + PL) and modalities will be assessed via individual semi-structured qualitative interviews with patients who participate in Activity 1 as well as clinicians or clinical leaders.</description>
    </secondary_outcome>
    <number_of_arms>5</number_of_arms>
    <enrollment type="Anticipated">2500</enrollment>
    <condition>Breast Cancer</condition>
    <arm_group>
      <arm_group_label>The Accountable Health Communities Health-Related Social Needs Screening Tool (AHC-HRSN)</arm_group_label>
      <arm_group_type>Other</arm_group_type>
      <description>Patients will be randomized to receive one of three social needs screening instruments. The AHC-HRSN is a 10-item tool developed by the Centers for Medicare and Medicaid Services to assess patient needs in 5 core domains, including housing instability, food insecurity, transportation problems, utility help needs, and interpersonal safety, with eight supplemental domains to collect information about financial strain, employment, family and community support, education, physical activity, substance abuse, mental health, and disabilities. The AHC-HRSN tool is designed to help physicians identify unmet needs and refer affected patients to appropriate community services.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Health Leads Social Screening Tool</arm_group_label>
      <arm_group_type>Other</arm_group_type>
      <description>Patients will be randomized to receive one of three social needs screening instruments. Health Leads is an 8-item survey with yes/no responses, which screens for food insecurity, utility needs, housing instability, childcare, financial resource strain, transportation challenges, education, and social isolation.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>National Comprehensive Care Network (NCCN) Distress Thermometer and Problem List (DT + PL)</arm_group_label>
      <arm_group_type>Other</arm_group_type>
      <description>Patients will be randomized to receive one of three social needs screening instruments. The NCCN Distress thermometer is a single-item tool designed to measure patients' current level of distress. Patients are asked to rate their distress using a 10-point Likert scale, where 0=no distress and 10=extreme distress. The Problem List (PL) helps physicians identify the sources of patients' distress and direct patients to appropriate support services. The NCCN DT+PL is a widely used, validated tool for evaluating distress in patients diagnosed with or receiving treatment for cancer.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Chatbot</arm_group_label>
      <arm_group_type>Other</arm_group_type>
      <description>Patients who do not respond to the survey within 48 hours of being first administered via MyPennMedicine will be sent the same survey via one of two modality arms. The chatbot is a bidirectional text-based conversational agent administered via WaytoHealth. Patients will again have 48 hours to respond via chatbot.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Interactive Voice Response (IVR) System</arm_group_label>
      <arm_group_type>Other</arm_group_type>
      <description>Patients who do not respond to the survey within 48 hours of being first administered via MyPennMedicine will be sent the same survey via one of two modality arms. The interactive voice response (IVR) system is administered via phone through WaytoHealth. Patients will be called over the phone and will receive the screening tool through IVR. Patients will again have 48 hours to respond via IVR.</description>
    </arm_group>
    <intervention>
      <intervention_type>Other</intervention_type>
      <intervention_name>Early Point-of-Service Social and Behavioral Determinants of Health (SBDOH) Screening</intervention_name>
      <description>All patients who participate in the trial will receive one of three social and behavioral determinants of health (SBDOH) screening instruments (AHC-HRSN, Health Leads, or NCCN DT + PL). Any patients who do not complete the screening within 48 hours of its administration will be randomized to receive the same screening via one of two modality arms (Chatbot or IVR System)</description>
      <arm_group_label>Chatbot</arm_group_label>
      <arm_group_label>Health Leads Social Screening Tool</arm_group_label>
      <arm_group_label>Interactive Voice Response (IVR) System</arm_group_label>
      <arm_group_label>National Comprehensive Care Network (NCCN) Distress Thermometer and Problem List (DT + PL)</arm_group_label>
      <arm_group_label>The Accountable Health Communities Health-Related Social Needs Screening Tool (AHC-HRSN)</arm_group_label>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
          Based on available EHR data, patients will be eligible for Activities 1 and 2 if they:&#xD;
  &#xD;
            -  Are referred to one of the following locations for surgical consult following a new&#xD;
               diagnosis of operable (Stage 0-III) breast cancer: the Hospital of the University of&#xD;
               Pennsylvania (HUP), Penn Presbyterian Medical Center (PPMC), Pennsylvania Hospital&#xD;
               (PAH), and Penn Medicine Radnor&#xD;
  &#xD;
            -  Are female&#xD;
  &#xD;
            -  Are 18 years of age or older, and&#xD;
  &#xD;
            -  Are able to read and speak English or Spanish&#xD;
  &#xD;
          Clinicians and clinical leaders will be eligible for participation in Activity 2 if they:&#xD;
  &#xD;
            -  Presently work as a clinician or clinical leader in breast surgery or oncology&#xD;
  &#xD;
            -  Access PennChart as an aspect of their clinical duties&#xD;
  &#xD;
            -  Are 18 years of age or older&#xD;
  &#xD;
            -  Are able to read and speak English or Spanish&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
          Based on available EHR data, patients will be ineligible if they:&#xD;
  &#xD;
            -  Are listed as not wanting to be contacted or solicited for research;&#xD;
  &#xD;
            -  Have known metastatic disease at time of enrollment; and/or&#xD;
  &#xD;
            -  Do not otherwise meet all of the enrollment criteria&#xD;
  &#xD;
          Clinicians and clinical leaders will be ineligible for participation in Activity 2 if they:&#xD;
  &#xD;
            -  Are not presently engaged in clinical duties or&#xD;
  &#xD;
            -  Do not otherwise meet all of the enrollment criteria&#xD;
  &#xD;
          This study will not exclude men or nonbinary people who may be diagnosed with breast&#xD;
          cancer, but investigators anticipate the sample size for these characteristics will be too&#xD;
          small to support meaningful analysis.&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>18 Years</minimum_age>
      <maximum_age>N/A</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <overall_official>
      <last_name>Oluwadamilola Fayanju, MD</last_name>
      <role>Principal Investigator</role>
      <affiliation>University of Pennsylvania Division of Breast Surgery</affiliation>
    </overall_official>
    <overall_contact>
      <last_name>Julia T Lewandowski</last_name>
      <phone>215-662-2861</phone>
      <email>julia.lewandowski@pennmedicine.upenn.edu</email>
    </overall_contact>
    <overall_contact_backup>
      <last_name>Sarah B Hulse</last_name>
      <phone>267-408-2477</phone>
      <email>sarah.hulse@pennmedicine.upenn.edu</email>
    </overall_contact_backup>
    <verification_date>September 2023</verification_date>
    <study_first_submitted>August 25, 2023</study_first_submitted>
    <study_first_submitted_qc>August 25, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">August 31, 2023</study_first_posted>
    <last_update_submitted>September 5, 2023</last_update_submitted>
    <last_update_submitted_qc>September 5, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">September 7, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Principal Investigator</responsible_party_type>
      <investigator_affiliation>Abramson Cancer Center at Penn Medicine</investigator_affiliation>
      <investigator_full_name>Oluwadamilola Fayanju, MD, MA, MPHS, FACS</investigator_full_name>
      <investigator_title>Principal Investigator</investigator_title>
    </responsible_party>
    <keyword>Social and behavioral determinants of health</keyword>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Breast Neoplasms</mesh_term>
    </condition_browse>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT06019988
  org study id: 19122
  nct id: NCT06019988
  lead sponsor: 
  collaborator: 
  has dmc: No
  is fda regulated drug: No
  is fda regulated device: No
  The overarching goal of this project is to optimize the collection of social and behavioral
        determinants of health (SBDOH) for patients with a pathological diagnosis of breast cancer at
        Penn Medicine. The investigators will measure rates of SBDOH data collection by modality and
        rates of referral to and uptake of social support services, time to evaluation, staff time,
        acceptability, patient-centered communication, medical mistrust, and clinician acceptability.
  The investigators will conduct a patient-level, pragmatic opt-out trial to test
        implementation of a comprehensive, tech-enabled platform for administration of a validated
        SBDOH screening tool in contrast to the current practice of unstructured social history
        collection at this institution.
  
        For internally referred patients, study coordinators - who are functioning as patient
        navigators - will facilitate a warm handoff from radiology to the New Patient Office as well
        as study introduction and enrollment. If patients do not wish to have a warm handoff call
        with a new-patient coordinator (NPC) in the NPO who will schedule the patient's consult with
        a surgeon and/or oncologist, or if patients are diagnosed external to Penn Medicine, the
        patient coordinator will follow up directly with the patient to facilitate communication and
        enrollment within 24 hours of diagnosis.
  
        All patients who do not opt out will be part of the analytic cohort and randomized to one of
        three screening assessment tools:
  
          1. Accountable Health Communities Health-Related Social Needs Screening Tool (AHC-HSRN);
  
          2. Health Leads Social Needs Screening Toolkit (Health Leads);
  
          3. National Comprehensive Cancer Network (NCCN) Distress Thermometer + Problem List (NCCN
             DT+PL).
  
             . The initial request for completion will be administered via the institutional EHR's
             Epic-based patient portal. Patients will have 48 hours to respond and will receive 2
             reminders via a MyPennMedicine message (MPM), through which a patient can also indicate
             a desire to opt-out if they wish.
  
             Patients who do not respond and remain enrolled will be randomized to either a
             bidirectional text-based conversational agent (i.e., "chatbot") or interactive voice
             response (IVR) system administered by phone. Through the first arm, patients will engage
             with the screening tool through an interactive two-way text messaging chatbot through
             WaytoHealth©. Through the second arm, patients will be called over the phone and will
             receive the screening tool through interactive voice recognition. Patients will again
             have 48 hours to respond and will receive 2 reminders via the modality to which they
             have been newly randomized. Patients have the opportunity to opt out through either
             modality and discontinue study.
  
             Patients who have not completed the screen via any modality by the time of their first
             surgical consult at Penn after diagnosis, will be provided the opportunity to complete
             it electronically though a tablet at the clinic appointment. At any point, patients who
             report challenges with particular SBDOH domains can be referred prior to initial
             surgical consultation to Social Services at Abramson Cancer Center.
  
             Approximately 6 months following diagnosis and initial completion in the study trial
             (Activity 1), a subset of patients (identified via deviant sampling) will be invited to
             participate in semi-structured interviews (Activity 2) through which mechanisms
             contributing to the effectiveness of the SBDOH data collection platform will be
             evaluated. Additionally, clinicians or clinical leaders will be invited to participate
             in semi-structured interviews.
  allocation: Randomized
  intervention model: Parallel Assignment
  intervention model description: All enrolled patients will initially receive one of three screening tools (The Accountable Health Communities Health-Related Social Needs Screening Tool [AHC-HRSN], Health Leads Social Screening Tool, or National Comprehensive Care Network Distress Thermometer and Problem List [NCCN DT+PL]) via the MyPennMedicine patient portal and be given 48 hours to respond. Those patients who do not respond will be randomized to one of two intervention arms, each of which is an alternative modality to receive and respond to the assigned screening tool: a bidirectional text-based conversational agent (chatbot) or interactive voice response system administered by phone.
  There exists three instrument arms (AHC-HRSN, Health Leads, and NCCN DT+PL) and two modality arms (chatbot and IVR).
  primary purpose: Screening
  masking: None (Open Label)
  measure: Rates of SBDOH screen completion prior to initial surgical consult
  time frame: 1 year
  description: Rates of SBDOH screen completion prior to initial surgical consult will be first compared by instrument (Accountable Health Communities Health-Related Social Needs Screening Tool [AHC-HRSN], Health Leads Social Needs Screening Toolkit [Health Leads], National Comprehensive Cancer Network Distress Thermometer and Problem List [NCCN DT + PL]). Only the NCCN DT employs a 10-point Likert scale, where 0 = no distress and 10 = extreme distress. Among patients who do not respond to initial screening administration and who then receive the screening via either chatbot or IVR, rates of SBDOH screen completion will be compared by modality.
  measure: Time from biopsy to initial surgical consult
  time frame: 1 years
  description: Time to evaluation (TTE) will be compared first by instrument (Accountable Health Communities Health-Related Social Needs Screening Tool [AHC-HRSN], Health Leads Social Needs Screening Toolkit [Health Leads], National Comprehensive Cancer Network Distress Thermometer and Problem List [NCCN DT + PL]). Only the NCCN DT employs a 10-point Likert scale, where 0 = no distress and 10 = extreme distress. Among patients who do not respond to initial screening administration and who then receive the screening via either chatbot or IVR, rates of SBDOH screen completion will be compared by modality.
  measure: Identify factors associated with rates of post-diagnosis, pre-consultation SBDOH screen completion
  time frame: 6 months
  description: Factors associated with rates of SBDOH screen completion across all instruments (AHC-HRSN, Health Leads, and NCCN DT + PL) and modalities will be assessed via individual semi-structured qualitative interviews with patients who participate in Activity 1 as well as clinicians or clinical leaders.
  arm group label: The Accountable Health Communities Health-Related Social Needs Screening Tool (AHC-HRSN)
  arm group type: Other
  description: Patients will be randomized to receive one of three social needs screening instruments. The AHC-HRSN is a 10-item tool developed by the Centers for Medicare and Medicaid Services to assess patient needs in 5 core domains, including housing instability, food insecurity, transportation problems, utility help needs, and interpersonal safety, with eight supplemental domains to collect information about financial strain, employment, family and community support, education, physical activity, substance abuse, mental health, and disabilities. The AHC-HRSN tool is designed to help physicians identify unmet needs and refer affected patients to appropriate community services.
  arm group label: Health Leads Social Screening Tool
  arm group type: Other
  description: Patients will be randomized to receive one of three social needs screening instruments. Health Leads is an 8-item survey with yes/no responses, which screens for food insecurity, utility needs, housing instability, childcare, financial resource strain, transportation challenges, education, and social isolation.
  arm group label: National Comprehensive Care Network (NCCN) Distress Thermometer and Problem List (DT + PL)
  arm group type: Other
  description: Patients will be randomized to receive one of three social needs screening instruments. The NCCN Distress thermometer is a single-item tool designed to measure patients' current level of distress. Patients are asked to rate their distress using a 10-point Likert scale, where 0=no distress and 10=extreme distress. The Problem List (PL) helps physicians identify the sources of patients' distress and direct patients to appropriate support services. The NCCN DT+PL is a widely used, validated tool for evaluating distress in patients diagnosed with or receiving treatment for cancer.
  arm group label: Chatbot
  arm group type: Other
  description: Patients who do not respond to the survey within 48 hours of being first administered via MyPennMedicine will be sent the same survey via one of two modality arms. The chatbot is a bidirectional text-based conversational agent administered via WaytoHealth. Patients will again have 48 hours to respond via chatbot.
  arm group label: Interactive Voice Response (IVR) System
  arm group type: Other
  description: Patients who do not respond to the survey within 48 hours of being first administered via MyPennMedicine will be sent the same survey via one of two modality arms. The interactive voice response (IVR) system is administered via phone through WaytoHealth. Patients will be called over the phone and will receive the screening tool through IVR. Patients will again have 48 hours to respond via IVR.
  intervention type: Other
  intervention name: Early Point-of-Service Social and Behavioral Determinants of Health (SBDOH) Screening
  description: All patients who participate in the trial will receive one of three social and behavioral determinants of health (SBDOH) screening instruments (AHC-HRSN, Health Leads, or NCCN DT + PL). Any patients who do not complete the screening within 48 hours of its administration will be randomized to receive the same screening via one of two modality arms (Chatbot or IVR System)
  arm group label: Chatbot
  arm group label: Health Leads Social Screening Tool
  arm group label: Interactive Voice Response (IVR) System
  arm group label: National Comprehensive Care Network (NCCN) Distress Thermometer and Problem List (DT + PL)
  arm group label: The Accountable Health Communities Health-Related Social Needs Screening Tool (AHC-HRSN)
  criteria: 
  gender: All
  minimum age: 18 Years
  maximum age: N/A
  healthy volunteers: No
  last name: Oluwadamilola Fayanju, MD
  role: Principal Investigator
  affiliation: University of Pennsylvania Division of Breast Surgery
  last name: Julia T Lewandowski
  phone: 215-662-2861
  email: julia.lewandowski@pennmedicine.upenn.edu
  last name: Sarah B Hulse
  phone: 267-408-2477
  email: sarah.hulse@pennmedicine.upenn.edu
  responsible party type: Principal Investigator
  investigator affiliation: Abramson Cancer Center at Penn Medicine
  investigator full name: Oluwadamilola Fayanju, MD, MA, MPHS, FACS
  investigator title: Principal Investigator
  mesh term: Breast Neoplasms