Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Head and neck cancer (HNC) outcomes are influenced by health disparities that arise from non-medical factors, collectively referred to as social determinants of health (SDoH). The role of the head and neck surgeon is pivotal in mitigating these inequities as they relate to patient care, and their perspectives are integral to interventions aimed to minimize SDoH impact on cancer outcomes. While interest in addressing SDoH within head and neck surgery is rising, no study has yet explored the perspectives of head and neck surgeons on the impact of SDoH on their patient population and how SDoH are utilized in their practice.
Methods: An anonymous 22 item questionnaire was distributed to members of the American Head and Neck Society (AHNS) regarding practice characteristics, accessibility of SDoH data, impressions of SDoH impact on patient outcomes, and how SDoH information is utilized in patient care. Univariate analyses performed for demographic variables, chi-square tests were utilized for categorical variables and further analyzed using Spearman’s rank order correlation.
Results: A total of 66 responses were recorded. Most respondents were White (62.1%), MD/DO attendings (89.4%), in practice for 10+ years (42.4%), practicing at academic institutions (66.7%), and in urban areas (83.3%). Most respondents deemed SDoH factors very impactful (80.3%) or moderately impactful (15.2%) on patient outcomes. When asked how many of their HNC patient’s outcomes were affected by at least one SDoH factor 40.9% responded most. Healthcare access and quality (53%) was the most impactful domain of SDoH, followed by economic stability (18.2%). Regarding screening, 24.2% of SDoH screening was navigator based and 21.2% of institutions did not routinely perform screening. If screening was performed, 45.5% stated they were sometimes able to intervene in SDoH prior to initiation of cancer treatment, followed by rarely (24.2%). Only 45.5.% of practitioners knew where to find SDoH factors in their EMR. Regarding the current literature on SDoH outcomes in HNC patients, 50% of respondents found it somewhat adequate followed by 19.7% who find it somewhat inadequate. When asked how often respondents used SDoH to aid in patient care decisions, 37.9% responded sometimes, followed by 33.3% who responded often.
Private practice physicians were more likely to rate literature as very adequate and somewhat adequate compared to academic practitioners (p<0.001). Longer time in practice was associated with the belief that most patient outcomes were affected by at least one SDoH factor (p=0.007) and associated with interest in importance for increasing financial incentives for physicians (p=0.024) and investment in community capacity to decrease the impact of SDoH (p=0.023). Geographically, compared to those in suburban setting, those in urban setting were more likely to answer that SDoH factors were very impactful (p=0.025).
Conclusions: This study reveals that while most practitioners believe that SDoH factors impact HNC patient outcomes, there are significant gaps in how SDoH screening and interventions are utilized in HNC patient care. Future studies are needed to investigate integration of SDoH considerations into clinical practice and policy, aiming to reduce disparities and improve outcomes in head and neck surgery.