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.