Social determinants of health and US cancer screening interventions: A systematic review

Abstract

There remains a need to synthesize linkages between social determinants of health (SDOH) and cancer screening to reduce persistent inequities contributing to the US cancer burden. The authors conducted a systematic review of US‐based breast, cervical, colorectal, and lung cancer screening intervention studies to summarize how SDOH have been considered in interventions and relationships between SDOH and screening. Five databases were searched for peer‐reviewed research articles published in English between 2010 and 2021. The Covidence software platform was used to screen articles and extract data using a standardized template. Data items included study and intervention characteristics, SDOH intervention components and measures, and screening outcomes. The findings were summarized using descriptive statistics and narratives. The review included 144 studies among diverse population groups. SDOH interventions increased screening rates overall by a median of 8.4 percentage points (interquartile interval, 1.8–18.8 percentage points). The objective of most interventions was to increase community demand (90.3%) and access (84.0%) to screening. SDOH interventions related to health care access and quality were most prevalent (227 unique intervention components). Other SDOH, including educational, social/community, environmental, and economic factors, were less common (90, 52, 21, and zero intervention components, respectively). Studies that included analyses of health policy, access to care, and lower costs yielded the largest proportions of favorable associations with screening outcomes. SDOH were predominantly measured at the individual level. This review describes how SDOH have been considered in the design and evaluation of cancer screening interventions and effect sizes for SDOH interventions. Findings may guide future intervention and implementation research aiming to reduce US screening inequities.

An Examination of Stakeholder-Driven Health-Related Social Needs Screening Tools in Medical Care Delivery

“…Screening alone is not enough; intimate integration with community-based resources to provide more comprehensive referrals must leverage the strengths of patients, families, and communities (Garg et al, 2016). The application of analytic tools will continue to build an evidence base for screening and addressing HRSNs, tracking meaningful impact, and measuring outcomes (Korn et al, 2023; Lee & Korba, 2017). Demonstrating return on investment could ignite social needs investments and sustainable funding through innovative value-based care models (Lee & Korba, 2017; Weir et al, 2020).…”

“…Research on the effectiveness of screening and social service interventions has historically lacked rigor and focused on process outcomes (Korn et al, 2023; Kreuter et al, 2021). Most HRSN screenings involve patient self-report (Adler & Stead, 2015) but vary in terms of the domains and needs assessed, number of questions, wording and response format, time interval assessment, modality of delivery (i.e., verbal, paper, tablet), and respondent as patient only or household (Kreuter et al, 2021).…”

Understanding the perceived benefits, barriers, and cues to action for lung cancer screening among Latinos: A qualitative study

“…Some of the perceived barriers to lung cancer screening characterize the social determinants of health (SDOH). The SDOH are factors outside of the realm of medicine that impact health outcomes ( 38 , 39 ). The SDOH include five interconnected domains: economic stability, education, neighborhood, built environment, social and community context, and access to care and health care quality ( 38 , 39 ).…”

“…The SDOH are factors outside of the realm of medicine that impact health outcomes ( 38 , 39 ). The SDOH include five interconnected domains: economic stability, education, neighborhood, built environment, social and community context, and access to care and health care quality ( 38 , 39 ). Cost and transportation as perceived barriers to lung cancer screening are part of economic stability.…”

A “call to bear the burden of a long twilight struggle”: a special issue on social determinants of health assessment and intervention

“…Collectively, these considerations are social determinants of health (SDOH) and cancer care ( 2 ). The field of cancer research persists in examining the role environment [eg, where we are born, grow, live, work, and age ( 3 )] plays in cancer screening ( 4 ), incidence ( 5 ), care ( 6 ), and mortality ( 7 ). Yet, movement from discovery to intervention befuddles us.…”