Discussion
The present study provides a detailed insight into barriers associated with recording patients’ social circumstances. This is important because using this information can facilitate patients’ access to the help and support they need to get the best out of their cancer treatment. Drawing on Kirk’s framework of barriers, we explored and identified both organizational and professional barriers to maintaining patients´ social histories.
We found that HPs preferred to form their own impression of patients rather than reading about them beforehand in the medical records. It was important for them to sustain a situational, individualized, open-minded approach to patients in order to treat them all equal respect and without prejudice. These good intentions may, however, have the opposite effect, if patients are not asked whether the HP’s ideas about them are in accordance with the patients’ own experiences. This disparity becomes critical when dealing with patients who do not proactively express their needs themselves. Several studies show that less socially adapted patients are less likely to share their experiences, to ask questions and to involve themselves actively in the treatment (25,26).
For example, a qualitative study that included 58 oncologists and 405 patients showed that younger patients, those who were white, had more than a high school education and reported high or medium income, asked and were asked more questions by physicians than non-white, less educated and less affluent patients. Further, physicians spent more time engaging in relationship-building with the socially most advantaged patients (25). The study suggests that physicians themselves are not aware of these tendencies, which might lead to disparities in patient outcomes (ibid). Another qualitative study including 73 men and women showed that more highly educated patients are more likely to perceive their involvement in healthcare decision-making as sharing the responsibility with the doctor, actively relating to and exploring information they receive. Less well-educated patients tended to construct their involvement in a more passive way, consenting or not consenting to recommendations presented by the doctor (26). If, therefore, HPs do not elicit patients’ own viewpoints but only trust their own impressions, they do not get to understand how patients’ social circumstances might influence the treatment of their disease.
We also found that organizational barriers reinforced professional barriers. So, when time was short, HPs tended to prioritize their own impressions over questioning the patient and recording their experiences and needs. Lack of time also led to a prioritization of medical information above social information. That said, HP’s situational approach to patient communication – articulated as ‘meeting patients where they are’ – seemed to be well-founded and provided professional value to HPs that might well co-exist with registering of patients´ social histories.