(0218) Evaluating Social Determinants of Health and Patient Perceptions of Head and Neck Cancer Treatment

Introduction: Social determinants of health (SDoH) impact access to and perceptions of care in head and neck cancer (HNC) patients, however qualitative information evaluating SDoH and patient-reported perceptions of HNC care is lacking. We designed a focus group study to evaluate patient perceptions of cancer care to evaluate barriers to care and guide quality improvement efforts.

Methods: This qualitative focus group study was the first phase of a survey development project. HNC patients were recruited from University of Maryland Medical Center. HNC patients with mucosal or salivary gland malignancies who underwent surgery, chemotherapy, and/or radiation were eligible. Patients completed a pre-session survey, and then focus group discussion questions explored perceptions of HNC care and barriers to care with themes ranging from baseline understanding of HNC to the role of support systems in decision making. The sessions were recorded, transcribed and key themes were extracted.

Results: In total, 12 patients were interviewed, including 5 female patients and 7 male patients. On the pre-session survey, 11 patients reported understanding their treatment options well. However, in discussion, patients expressed lack of prior knowledge about HNC treatment and the significance of communication from providers. Similarly, 75% of patients denied difficulty completing cancer treatment, but focus group discussions revealed large variations in perceptions of treatment associated with education level, stable work, and transportation. Patients with higher incomes and job flexibility had fewer concerns regarding the demands of treatment. Further, patients who had access to health care providers and the internet outside of the clinical setting were able to obtain more information about treatment options, affecting their perception of treatment and side effects.

Conclusions: In this study, we qualitatively establish that SDoH can shape patient decision making and impact the cancer treatment continuum. Development of survey instruments to understand these factors will allow better identification of interventions to provide equitable HNC care.