Implementing an electronic health record workflow to identify parents with cancer and implications for supportive oncology care

Clinical Snapshot

Key Findings

• P Value: Distress p=0.003; Anxiety p=0.009

• Effect Size: Parents had 35% higher odds of distress (OR=1.35) and 28% higher odds of anxiety (OR=1.28)

• Primary Outcome: 20.6% of cancer patients identified as parents (age-adjusted prevalence 16.9%)

• Nnt Or Sensitivity: EHR screening captured 79.4% of identified parents during implementation phase

• Confidence Interval: Distress OR 95% CI: 1.11-1.64; Anxiety OR 95% CI: 1.06-1.52

Clinical Application

High feasibility demonstrated with successful integration into routine oncology workflows Applicable to Australian cancer centers using electronic medical records; aligns with Cancer Australia's supportive care guidelines and could integrate with existing psychosocial screening programs Adult cancer patients in comprehensive cancer centers with EHR systems

Abstract

PURPOSE: Parents with cancer face unique psychosocial challenges as they navigate treatment while caring for dependent children, yet parenthood status is rarely captured in oncology workflows. This initiative evaluated the feasibility and outcomes of a new electronic health record (EHR)-based workflow to systematically identify parents with cancer and then connect them to family-focused assessment and supportive care. METHODS: A two-phase quality improvement initiative was conducted at an NCI-designated comprehensive cancer center. Phase 1 included process mapping, analysis of tumor registry and distress screening data, and development of an EHR screening item assessing parenting status. Phase 2 implemented the item ("Patient is a parent/caregiver with child/ren < 22 years of age?") into oncology workflows, linking identified parents to a new supportive care program, Family Circle, which includes psychosocial assessment, navigation, and family-centered support. Training for oncology clinicians included in-service education. Analyses examined prevalence estimates and associations between parenting, distress, anxiety, and depression and reports of quality improvement metrics. RESULTS: Among N = 2,172 screened patients, 20.6% identified as parents; the age-adjusted prevalence of parenting with children under 21 was 16.9%, consistent with national estimates. Parents reported significantly higher distress (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.11-1.64, p = 0.003) and anxiety (OR = 1.28, 95% CI = 1.06-1.52, p = 0.009) than matched non-parents. Parents with younger children exhibited greater anxiety than those with older children (F = 4.32, df = 2, 393, p = .01). During implementation, N = 431 parents were identified in 6 months (79.4% through the EHR item). CONCLUSION: Embedding parenting status screening into the EHR is feasible, accurate, and critical for linking parents with cancer to supportive care. Wider implementation of such workflows may enhance psychosocial oncology practice and improve cancer parenting outcomes.

References

1. 1.Tercyak, K. P., Sleiman, M. M., Akand, A., Statman, M. R., Adams, R. M., Biel, M. G., Davis, K. M., Zhang, R., Ahn, J., Marshall, J. L., Gaines, A. G., & Sharkey, C. (2026). Implementing an electronic health record workflow to identify parents with cancer and implications for supportive oncology care. Supportive Care in Cancer. https://doi.org/10.1093/nop/npw015