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.