Social determinants of health among family caregiver centered outcomes in lung cancer: a systematic review

Abstract

Background Lung cancer is the leading cause of cancer death globally. Both lung cancer patients and family caregivers (FCGs) have unmet quality of life (QOL) needs. An understudied topic in lung cancer research is the role of social determinants of health (SDOH) on QOL outcomes for this population. The purpose of this review was to explore the state of research on SDOH FCGs centered outcomes in lung cancer. Methods The databases PubMed/MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and American Psychological Association (APA) PsycInfo were searched for peer-reviewed manuscripts evaluating defined SDOH domains on FCGs published within the last ten years. The information extracted using Covidence included patients, FCGs and study characteristics. Level of evidence and quality of articles were assessed using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. Results Of the 344 full-text articles assessed, 19 were included in this review. The social and community context domain focused on caregiving stressors and interventions to reduce its effects. The health care access and quality domain showed barriers and underuse of psychosocial resources. The economic stability domain indicated marked economic burdens for FCGs. Four interconnected themes emerged among articles on the influence of SDOH on FCG-centered outcomes in lung cancer: (I) psychological well-being, (II) overall quality of life, (III) relationship quality, and (IV) economic hardship. Notably, most participants in the studies were White females. The tools used to measure SDOH factors included primarily demographic variables. Conclusions Current studies provide evidence on the role of SDOH factors on lung cancer FCGs’ QOL. Expanded utilization of validated SDOH measures in future studies would provide greater consistency in data, that could in turn inform interventions to improve QOL. Further research focusing on the domains of education quality and access and neighborhood and built environment should be carried out to bridge gaps in knowledge.

Social determinants of health and lung cancer surgery: a qualitative study

“…Codes and subsequent themes were derived from participants' interviews and relevant research, or theory was used to interpret meaning from data. Our research team published a systematic literature review on the impact of SDOH on FCG as well as lung cancer patients which informed our interpretation of the data for this study (4). We used the US Department of Health and Human Services' SDOH framework which includes five broad domains: economic stability, education access and quality, neighborhood and built environment, healthcare access and quality, and social and community context.…”

“…Moreover, social and community factors can determine patients' QOL throughout their survivorship journey (4). Factors related to their psychosocial wellbeing, community engagement, and social support availability contribute to their health (1).…”

“…SDOH are organized into five broad domains: economic stability, education access and quality, neighborhood and built environment, healthcare access and quality, and social and community context (3). While understudied in oncology research, SDOH factors impact the QOL of patients and their family caregivers (4).…”

“…Despite the proven effectiveness of screening for early detection, access is not equitably distributed (5). Patients also experience several detrimental health outcomes throughout their survivorship journeys that are compounded by SDOH factors (4). Non-clinical factors such as race/ethnicity, insurance status, education, neighborhood features, and income have been associated with perioperative complications and survival following surgery (6).…”

“…Thus, an individual's geographical residence may determine their treatment and survival (36)(37)(38). However, the current literature on the impact of SDOH on lung cancer patient outcomes is limited and focused primarily on healthcare access and quality, economic stability, and social and community context domains (4). Research on lung cancer surgery patients is also lacking narratives from this population and warrants additional inquiry (6).…”