Background
Across all cancer sites, risk and survival are reflected in social
inequalities, observed as differences in stage at diagnosis and in
access to treatment and rehabilitation and in survivorship relative to
socio-economic position (1,2,3,4). While this general picture of social
inequality in cancer has been documented over the past decade or so,
knowledge about patients’ social circumstances (e.g. employment, housing
condition and family relationships), social network, educational
background, health literacy and mental wellbeing is not routinely
assessed in medical practice (5,6,7,8).
This is a problem, since research points to the advantages of healthcare
professionals (HPs) systematically registering patients’ social data and
using the information when communicating with them about their
treatment. According to Adler & Stead 2015 and Diez Roux et al 2015
(9,10), assessing information on education, social network and physical
activity leads to a) greater precision in diagnosis and treatment
through reduction of bias and improved risk stratification, b) more
effective decisions, because clinicians suggest more informed and
realistic treatment, c) improved detection of social or behavioural risk
factors, and d) improvement in care and speed of recovery. Finally,
knowledge about patients’ social circumstances also allows referrals to
relevant services in cases of social isolation, malnutrition (10,11),
for financial counselling (9) and helps in managing chronic conditions
such as diabetes (9). Despite these important findings, knowledge about
patients’ social background is not systematically made available.
Our study therefore aimed to
explore HP’s barriers to recording patients’ social history. In our
theoretical considerations we follow Kirk et al. (12), who distinguish
three levels of barrier as regards mobilization practices in hospital
settings: organizational, professional and individual. Organizational
barriers might involve shortages of staff and time or issues of teamwork
and communication; professional barriers to perceptions of HP’s
professional identity understood as ‘a profession´s way of thinking,
language codes, explanatory forms and routines of action and what they
consider to be their core tasks’ (12, p. 2); individual barriers to HP’s
doubts and fears concerning their professional tasks (12). In the
context of our study, we address professional values rather than HP’s
individual feelings and have chosen to highlight the category of
professional barriers.