Moving beyond Table 1: A critical review of the literature addressing social determinants of health in chronic condition symptom cluster research

Abstract

Variability in the symptom experience in patients diagnosed with chronic conditions may be related to social determinants of health (SDoH). The purpose of this critical review was to (1) summarize the existing literature on SDoH and symptom clusters (i.e., multiple, co‐occurring symptoms) in patients diagnosed with common chronic conditions, (2) evaluate current variables and measures used to represent SDoH, (3) identify gaps in the evidence base, and (4) provide recommendations for the incorporation of SDoH into future symptom cluster research. We identified 118 articles including information on SDoH in chronic condition symptom cluster research. Articles primarily focused on cancer populations. Few articles had the explicit purpose of investigating relationships between SDoH and symptom clusters, and the inclusion of SDoH was often limited to variables used to describe samples. Future studies should be designed to “move beyond Table 1” in their utilization of SDoH as variables and examine relationships between SDoH and symptom clusters. Attention should be paid to the appropriateness of measures being used to collect information on SDoH, and analysis methods that estimate causal connections between variables should be considered. Research regarding the relationship of SDoH with symptom clusters in patients with chronic conditions has the potential to reveal mechanisms of symptom disparities and guide changes to alleviate these disparities.

What is “determinant” in the social determinants of health? A case seen through multiple lenses

“…Yet an emerging cohort of writers is challenging the way determinants are conceptualized. Grayson et al (2022), for example, observe that many studies reduce social determinants to mere demographic characteristics, descriptive items from a patient intake screening to be transferred to a manuscript table, without substantive analysis of the mechanisms by which they actually influence health experience. Fornili (2022), citing McGibbon (2021), has argued for a more ethics‐oriented “expanded conceptual framework” identifying injustices “further upstream and farther downstream” from the “factors” and “domains” that appear in nursing social‐determinants policy and training documents.…”