Social determinants of health and associated access barriers cause disparities in experiences and outcomes of cancer care, perpetuating disadvantage. To remove access barriers, they must first be identified; however, no evidence-based tool exists to facilitate timely identification of disadvantage among newly diagnosed cancer patients. Consequently, we developed a nursing checklist (the Checklist) in consultation with 100 senior cancer nurses and piloted with 50 cancer patients. The current study aimed to assess key clinical utility aspects (acceptability, appropriateness, practicability) of the Checklist in newly diagnosed cancer patients.
A prospective mixed-methods study was conducted at a specialist cancer hospital. Newly diagnosed genitourinary, gynaecological, head and neck, and lung cancer patients, and clinical nurse consultants involved in their care were invited to participate. A target of up to 60 newly diagnosed patients was stipulated but halted when data saturation was achieved. The Checklist was completed as part of usual care. Semi-structured interviews explored the Checklist’s acceptability, appropriateness, and practicability. Interview data were analysed using content analysis.
Thirty-seven patients and seven nurses participated. Findings indicate the Checklist is highly acceptable and appropriate, and has potential to improve patient outcomes. Practicability findings suggested improvements to the Checklist and training, and barriers and enablers for implementation were discussed. Nurse participants highlighted the potential of the Checklist to inform optimal individual-level care, and improve service design at the health service-level through routine collection of social determinants data on service users.
Patients and cancer nurses affirmed the appropriateness and acceptability of the Checklist, and its potential to improve patient outcomes. Routine screening for social determinants of health may improve equity of opportunity for disadvantaged populations to access timely and appropriate care. A social determinants minimum dataset provides opportunity to embed an equity lens into health services research to guide service innovation.