Implementation and evaluation of the Routine Assessment and Integration of Screening for Employment (RAISE) program in adults with metastatic breast cancer

Purpose Adults living with metastatic breast cancer (mBC) often have unmet employed-related needs. To address this gap, we developed, implemented, and evaluated the Routine Assessment and Integration of Screening for Employment (RAISE) program for adults with mBC.Methods We designed a quality improvement project informed by the Specific, Measurable, Attainable, Relevant, and Timebound framework. In Phase 1 (development), we built and integrated an English/Spanish screener into the electronic health record (EHR) platform. In Phase 2 (implementation), 48 h before an oncology visit, patients received alerts through the patient portal that a screening assessment was available. Patients who reported needing support for employment-related concerns triggered an EHR alert to a patient navigator who reached out to offer educational resources (physical booklet and/or mobile app). Phase 3 (evaluation) was guided by the RE-AIM framework and included surveys and interviews with patients, providers, and staff to evaluate acceptability and feasibility of RAISE.Results Between March 2024 and August 2025, 179 patients with mBC completed the RAISE screener Of these, 22 (22/179, 12.2%) requested assistance/navigation and were provided with educational resources. Among 41 (41/179, 23%) patients surveyed (evaluation phase), 33 patients had completed the screener, and 8 had not. Of those who completed the screener and the evaluation survey, 91% (29/33) reported they were somewhat or very satisfied with RAISE and 78% (25/33) reported the EHR screening questions were clear to them. Key themes that emerged from 5 patient and 10 provider interviews included utility of the resources offered, screening preferences, and barriers to incorporation of screening into the clinical workflow.Conclusions Screening for unmet employment needs and delivering resources and navigation is preliminarily feasible and acceptable to patients with mBC, providers, and staff at two NYC hospitals, though key barriers to implementation exist, including low pre-visit screening uptake and integration into the clinical workflow.Clinical trial number Not applicable.