Abstract
Introduction: Social determinants of health (SDoH) are the factors that affect a patient’s health quality and outcomes and contribute to health disparities. Evidence suggests that clinical care contributes only 20% to patients’ health outcomes, while the remainder is under the influence of upstream factors. The upstream approach to healthcare aims to address SDoH before they contribute to less ideal outcomes downstream. Several SDoH may contribute to outcomes for cancer patients. This Upstream Gynecologic Oncology Initiative seeks to identify which SDoH affect a population of patients with gynecologic malignancies. Hypothesis: This study hypothesizes that women receiving care for gynecologic malignancies are affected by specific SDoH among the categories of housing, food, transportation, finances, health literacy and social support. This study aims to identify the frequency of these six social factors among the outpatient gynecologic oncology population at the University of Iowa. Methods: This needs assessment is the first phase in a quality improvement project assessing the SDoH affecting women with gynecologic cancers. Two hundred twenty-two patients receiving outpatient care for gynecologic malignancies completed an anonymous needs assessment survey. Validated survey questions regarding housing, food, transportation, finances, health literacy and social support were used to identify needs. Responses were considered positive if any degree of need was reported. Results: Responses demonstrated the most substantial need in the categories of social support (32%), health literacy (28%) and financial stability (24%). Less need was reported in the categories of food (11%), transportation (5%) and housing (4%). Fifty-seven percent of women reported at least one social need among the six categories screened. Conclusion: Upstream SDoH, most notably social support, health literacy and financial stability are identified to be present and likely contributing to health quality, outcomes, and disparities within this gynecologic oncology patient population. Overall, these findings support the idea that SDoH should be assessed for each unique patient population - and for each patient receiving care for gynecologic cancer. While social support was the most frequently reported SDoH, many patients already received adequate help at home; suggesting that meaningful efforts should next be directed at improving health literacy in the population. Appreciation and assessment of SDoH potential to impact care and management should be used to design a routine screening tool for the study population and organize resources to address or mitigate the identified needs.
Highlights
Social determinants of health (SDoH) are the factors that affect a patient’s health quality and outcomes and contribute to health disparities
These findings support the idea that SDoH should be assessed for each unique patient population - and for each patient receiving care for gynecologic cancer
While social support was the most frequently reported SDoH, many patients already received adequate help at home; suggesting that meaningful efforts should be directed at improving health literacy in the population
Summary
Social determinants of health (SDoH) are the factors that affect a patient’s health quality and outcomes and contribute to health disparities. The incidence and outcomes of gynecologic malignancies are disparate among various populations of women due in part to the influence of social determinants of health (SDoH).[1] While health disparities are the differences in health quality and outcomes among patients that are related to social, economic, or environmental conditions[1]; SDoH are the actual factors such as lifestyle, age, and environment that affect a patient’s health quality and outcomes.[1,2,3,4] Surprisingly, evidence suggests that clinical care by providers contributes only 20% to patient health quality and outcomes, while the remaining 80% is directly related to upstream social determinants of health.[2] An ‘upstream’ approach to healthcare aims to address SDoH before they contribute to less ideal outcomes downstream.[3] An upstream approach to gynecologic oncology seeks to mitigate health disparities by intervening upon the SDoH most affecting this patient population, thereby improving the delivery of cancer care.[1]. While extensive research has been done on SDoH for various types of cancer (colorectal, cervical, breast) less has been done to study specific SDoH in women receiving care for all types of gynecologic malignancies.[4,6,8,25] The upstream approach maintains that the first step of mitigating negative effects of SDoH, is to identify which social factors are present in this patient population
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