Social determinants of health in lung cancer surgery: perspectives from family caregivers, clinicians, and healthcare system administrators

Introduction: Social Determinants of Health (SDoH) play an integral role in health outcomes across the cancer care continuum. Despite growing recognition of SDoH in healthcare, gaps exist in systematically identifying associated social risks and needs. Insights from multiple stakeholders are necessary to optimize integration of SDoH assessments in care delivery. This study examined the impact of SDoH on lung cancer care from the perspectives of key stakeholders, including family caregivers (FCGs), providers, and healthcare system administrators, all pivotal members in care delivery and decision-making. Methods: This qualitative study was conducted at a comprehensive cancer center. Participants were interviewed regarding the integration of SDoH assessments into cancer care. Conventional content analysis was used to generate codes and themes from these key informant interviews. SDoH information were collected using the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) survey. Descriptive statistics were conducted for FCGs, and data were summarized using counts and percentages. Results: FCGs (n = 13) were predominantly non-Hispanic White females ages 60–68; other participants were five providers, (a nurse practitioner, three thoracic surgeons), and two administrators. Six themes and 19 sub-themes emerged. Participants had diverse knowledge across SDoH domains and suggested a variety of strategies for reducing caregiving burden. Three themes informed provider and administrator perspectives on the importance of integrating SDoH assessments into care delivery, with electronic health record (EHR) systems using interdisciplinary approaches that include FCG perspectives. Integrating SDoH into routine care was regarded as particularly complex in the context of lung cancer surgery, where the clinical focus is mostly on patient survival. Discussion: Addressing SDoH in cancer care delivery is complex yet essential. Systematic documentation, leveraging EHR systems, and interdisciplinary workflows are necessary to advance these efforts.