Establishing a Multidisciplinary Approach to Social Determinants of Health

Cancer is a major public health concern that is expected to impact 2 million people in the year 2024, with an estimated number of 611,720 expected deaths.¹ A cancer diagnosis does not discriminate based on race, ethnicity, gender, sexual identity, socioeconomic status, or geographic location. However, these factors are social determinants of health that may impact treatment outcomes, treatment adherence, and survival rates. 

The National Cancer Institute defines health disparities as differences between certain demographics affecting access to proper health care services. These differences are determined by the social factors mentioned. Some of the main disparities that patients face include access to screening services; treatment options; lack of insurance; psychosocial support; mental health support; and assistance with basic needs such as housing, food, and transportation.² While research on health disparities and how to address them at a larger scale is rapidly increasing, healthcare professionals can actively seek ways to address health disparities on an individual level. 

Patient-Centered Model 

Patient-centered care is an approach designed to prioritize patients’ individual needs, values, and preferences.³ Hospitals and cancer centers typically implement programs and psychosocial services providing patient-centered care. These programs and services may focus on addressing barriers to care such as financial assistance for cancer treatment, medications, issues with transportation, access to psychosocial support, and other barriers that may be related to health disparities. 

Nurse navigators, hospital social workers, and patient navigators each provide an essential function in delivering comprehensive and holistic support to the patient receiving cancer care. Establishing a cohesive multidisciplinary approach is crucial to patient-centered care to properly address health disparities and service gaps. 

An important factor is that not all cancer centers and providers incorporate an interprofessional team composed of these professionals. However, establishing cohesiveness between disciplines within patient care may directly address health disparities on an individual level without duplication of services.

Understanding and Delineating Each Role 

To establish a collaborative approach there must be a clear definition of the roles in each discipline and its functions. Disparities may range from the importance of health literacy to address treatment adherence, to needing assistance with coordinating appointments, to discussing side effects and ways to manage them, to addressing depression or anxiety that is directly related to the cancer diagnosis, to needing assistance with finances. 

Social workers, nurse navigators, and patient navigators have a mutual purpose, which is to identify barriers and provide guidance, referrals, and resources that address the barriers identified. These 3 disciplines also utilize similar tools to determine areas of need such as distress screeners, needs assessments, and other forms of assessment tools. 

Although the tools utilized are similar, they operate at various levels of support and have different scopes of practice. A nurse navigator may be the healthcare professional that spends the most time with the patient in a 1-on-1 setting. Nurse navigators’ main task is facilitating coordination of care; providing educational information regarding diagnosis and treatment, including side effects; and providing referrals to needs outside of the scope. Nurse navigators also may be able to connect with oncologists regarding their patients’ concerns and progress. 

Social workers may have distinct roles depending on the healthcare setting. However, the main role of any social worker is to address psychosocial concerns and mental health issues that may interfere with patients’ adherence to treatments or access to care, as well as providing self-advocacy tools and techniques. 

A patient navigator may have similar functions to a nurse navigator or a social worker, and social workers may also have the title of a patient navigator depending on the setting and organizational structure. However, this role has increasingly shifted to being fulfilled by survivors and community members.⁴ 

How to Establish a Collaborative and Cohesive Approach 

Once the roles of the treatment team have been clearly defined, several strategies must be implemented to foster a collaborative approach. Although treatment centers may not have all 3 disciplines established in a team, these strategies can still be useful in bridging any gaps in services and providing patient-centered care.⁵ 

• Channels of communication A clear channel of communication must be established within the team. This includes having interdisciplinary team meetings, electronic communication platforms, and standardized communication procedures. Creating channels of communication gives the team an opportunity to ensure they are informed about patients’ care plans, updates, and any changes within their treatment and treatment protocol. Having interdisciplinary team meetings also offers insights on trends with patients, barriers, and access to care. 
• Continuing education and training Although each respective professional must continue their education to maintain their licensing, offering well-rounded training to all members of the team is crucial in advancing oncology care, supportive interventions, and improving skills and techniques. Training can be geared towards trends the team has been noticing within their populations, as well as training in cultural humility, shared decision making, clinical trials, new and emerging treatments for cancer, disparities, etc. 
• Quality improvement Establishing quality improvement initiatives will help ensure that the quality of care provided is consistent with patient and institutional goals. This can be done via monitoring, feedback from the team, feedback from patients, and data-driven reports. This can also help identify specific needs for services, or duplication of services. 
• Employee emotional support and wellness initiatives Recognizing the emotional toll of working in oncology is imperative. The field is often demanding, and burn out and/or compassion fatigue is a common experience among employees. Research shows that burnout and compassion fatigue impact the quality of care and support helping professionals provide to their patients. Wellness initiatives such as yoga, meditation, and peer-to-peer support can facilitate coping skills and resilience.

There are many ways to address health disparities within different levels and systems. Although most healthcare professionals won’t have the tools, bandwidth, or roles to address health disparities on a large scale, a cohesive interdisciplinary team can address health disparities at an individual level. Cohesiveness can enhance creativity through different perspectives, shared responsibility and accountability, and promoting problem solving by integrating a range of expertise. 

Further Reading

Kirschbaum S. The social work perspective: a systematic review of best practices for social workers in healthcare teams. St Paul, MN: Sophia, the St. Catherine University repository website; 2017. Accessed March 7, 2024. https://sophia.stkate.edu/cgi/viewcontent.cgi?article=1858&context=msw_papers

American Association for Cancer Research (AACR). Overcoming cancer health disparities through science-based public policy. In: AACR. AACR Cancer Disparities Progress Report 2022. Philadelphia: American Association for Cancer Research; April 14, 2021. Accessed March 7, 2024. https://cancerprogressreport.aacr.org/wp-content/uploads/sites/2/2022/06/AACR_CDPR_2022.pdf

Taberna M, Gil Moncayo F, Jané-Salas E, et al. The multidisciplinary team (MDT) approach and quality of care. Front Oncol. 2020;10:85. doi:10.3389/fonc.2020.00085

Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care, 2013;13:e010. doi:10.5334/ijic.886

Wells KJ, Valverde P, Ustjanauskas AE, Calhoun EA, Risendal BC. What are patient navigators doing, for whom, and where? A national survey evaluating the types of services provided by patient navigators. Patient Edu Couns. 2018;101(2):285-294. doi:10.1016/j.pec.2017.08.017