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      Social determinants of health and lung cancer surgery: a qualitative study

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          Abstract

          Introduction

          Social determinants of health (SDOH) are non-clinical factors that may affect the outcomes of cancer patients. The purpose of this study was to describe the influence of SDOH factors on quality of life (QOL)-related outcomes for lung cancer surgery patients.

          Methods

          Thirteen patients enrolled in a randomized trial of a dyadic self-management intervention were invited and agreed to participate in semi-structured key informant interviews at study completion (3 months post-discharge). A conventional content analysis approach was used to identify codes and themes that were derived from the interviews. Independent investigators coded the qualitative data, which were subsequently confirmed by a second group of independent investigators. Themes were finalized, and discrepancies were reviewed and resolved.

          Results

          Six themes, each with several subthemes, emerged. Overall, most participants were knowledgeable about the concept of SDOH and perceived that provider awareness of SDOH information was important for the delivery of comprehensive care in surgery. Some participants described financial challenges during treatment that were exacerbated by their cancer diagnosis and resulted in stress and poor QOL. The perceived impact of education varied and included its importance in navigating the healthcare system, decision-making on health behaviors, and more economic mobility opportunities. Some participants experienced barriers to accessing healthcare due to insurance coverage, travel burden, and the fear of losing quality insurance coverage due to retirement. Neighborhood and built environment factors such as safety, air quality, access to green space, and other environmental factors were perceived as important to QOL. Social support through families/friends and spiritual/religious communities was perceived as important to postoperative recovery.

          Discussion

          Among lung cancer surgery patients, SDOH factors can impact QOL and the patient’s survivorship journey. Importantly, SDOH should be assessed routinely to identify patients with unmet needs across the five domains. SDOH-driven interventions are needed to address these unmet needs and to improve the QOL and quality of care for lung cancer surgery patients.

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          Most cited references63

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          Three approaches to qualitative content analysis.

          Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.
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            The Social Determinants of Health: It's Time to Consider the Causes of the Causes

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              The Duke University Religion Index (DUREL): A Five-Item Measure for Use in Epidemological Studies

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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/2256739/overviewRole: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role:
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                URI : https://loop.frontiersin.org/people/127326/overviewRole:
                URI : https://loop.frontiersin.org/people/200209/overviewRole:
                URI : https://loop.frontiersin.org/people/127160/overviewRole: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role:
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                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                31 October 2023
                2023
                : 11
                : 1285419
                Affiliations
                [1] 1Department of Health Sciences, Crean College of Health and Behavioral Sciences, Chapman University , Orange, CA, United States
                [2] 2Division of Nursing Research and Education, Department of Population Sciences, City of Hope Comprehensive Cancer Center , Duarte, CA, United States
                [3] 3Division of Biostatistics, Department of Computational and Quantitative Medicine, Beckman Research Institute of City of Hope , Duarte, CA, United States
                [4] 4School of Public Health, Brown University , Providence, RI, United States
                [5] 5Department of Surgery, City of Hope Comprehensive Cancer Center , Duarte, CA, United States
                [6] 6School of Behavioral Health, Loma Linda University , Loma Linda, CA, United States
                [7] 7Department of Community Health and Preventive Medicine, Morehouse School of Medicine , Atlanta, GA, United States
                Author notes

                Edited by: Andrzej Klimczuk, Warsaw School of Economics, Poland

                Reviewed by: Soo-Dam Kim, Korea Institute of Oriental Medicine (KIOM), Republic of Korea; Enshe Jiang, Henan University, China

                *Correspondence: Virginia Sun, vsun@ 123456coh.org

                These authors have contributed equally to this work

                Article
                10.3389/fpubh.2023.1285419
                10644827
                38026333
                42156c96-cb56-4af3-adeb-1745ede35a20
                Copyright © 2023 Teteh, Ferrell, Okunowo, Downie, Erhunmwunsee, Montgomery, Raz, Kittles, Kim and Sun.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 29 August 2023
                : 05 October 2023
                Page count
                Figures: 0, Tables: 7, Equations: 0, References: 67, Pages: 16, Words: 14847
                Funding
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The research reported in this study is supported by the National Cancer Institute of the National Institutes of Health under award number 3R01CA217841-03S1. The statements presented in this article are solely the responsibility of the author(s) and do not necessarily represent the official views of the National Institutes of Health.
                Categories
                Public Health
                Original Research
                Custom metadata
                Life-Course Epidemiology and Social Inequalities in Health

                cancer,community support,lung cancer surgery,patients,oncology,quality of life,social determinants of health,structural determinants of health

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