Q&A: More integration of social determinants of health needed in ICU
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Key takeaways:
- Discussion on social determinants of health occurred infrequently in the ICU.
- Failing to obtain data on social determinants of health during care could negatively impact patients.
When talking to ICU patients, clinicians often fail to ask about social determinants of health, and this may be due to a lack of a standard for this type of data collection, according to results published in CHEST Critical Care.
In this study, Deepa Ramadurai, MD, fellow in the pulmonary, allergy and critical care department at Perelman School of Medicine at the University of Pennsylvania, and colleagues assessed more than 200 observation hours of clinical work rounds to find out the ways in which ICU clinicians integrate social determinants of health in their routine care.
Healio spoke with Ramadurai to learn more about findings from this study, social determinants of health and why this information is important in the ICU.
Healio: How would you define “social determinants of health,” and could you provide some examples?
Ramadurai: Social determinants of health are lived experiences that impact the risk factors for, diagnosis of, treatment for and recovery from illness. Examples of social determinants of health include the ability to access clean water, nutritious food and safe housing, or the experience of incarceration or housing insecurity. Less commonly considered social determinants of health are one’s interaction with one’s neighborhood or involvement in the community.
Healio: Why is an understanding of social determinants of health necessary in critical care? How can this information positively and negatively change patient outcomes?
Ramadurai: Critical care represents an extreme of health, where patients are at their most vulnerable. Social determinants may not be something routinely associated with critical illness, but the summation of lived experiences that are the social determinants of health are often confounded in the presentation of and therefore outcomes of critical illness. Understanding these lived experiences humanizes our patients and allows us to connect with them when they are experiencing fear, exhaustion, pain and uncertainty.
I believe that clinicians who ask about and integrate social determinants of health into their care for critically ill patients may find unique ways to address issues such as medication adherence or access to outpatient care.
Having a clinician take a moment to think about illness in the context of the patient’s life can go a long way in building trust and strength in the patient-clinician relationship.
Healio: What was the inspiration behind this study?
Ramadurai: I love to hear my patients’ stories. When I can hear from my patients and their loved ones the narrative of what brought them to my care, it helps me understand how I can best support their health and their lives.
During my medical training, I saw themes of patients who identified with groups that are historically, socially and economically marginalized in our society. I felt it was my responsibility as their physician and advocate to tell their story justly and provide the highest level of care to them. As I encountered barriers in telling their stories and addressing their needs, I became interested in how communication surrounding social determinants of health in clinical practice can shape narratives and alter care.
Healio: What was the main finding from your research in three urban ICUs?
Ramadurai: We found that although the words “social determinants of health” were not routinely used in a clinical setting, there are opportunities to incorporate questions about social determinants naturally in querying the etiology of critical illness, discussing life-sustaining therapies and at transitions of care. Without a structured way to integrate social determinants of health in care for critically ill patients, we may open ourselves to bias and miss opportunities to impact patient-centered outcomes.
Healio: What should ICU clinicians take away from this study? How can they incorporate the collection of social determinants of health in their daily care?
Ramadurai: ICU clinicians should reflect on how they interpret social determinants of health in their critically ill patients and when they are eliciting these issues. Since I believe strongly in the power of the narrative, I think ICU clinicians should incorporate the collection of social determinants of health routinely in clinical practice. However, it remains to be determined if this is both feasible and effective for patient-centered outcomes.
Healio: What do you have planned for future research?
Ramadurai: We have a follow-up study where we interviewed clinicians who participated in our observational ethnographic work to understand their ideas, opinions and beliefs around operationalizing social determinants of health in the ICU. This study is currently being finalized, with hopes to submit it for publication in the next month or so.