Publication Date


Document Type

Doctoral Dissertation

Academic Program

Clinical and Population Health Research


Population and Quantitative Health Sciences

First Thesis Advisor

Stephenie C. Lemon


Psychosocial DIstress, Screening, Lung Cancer, Social Determinants of Health, Time to Treatment, Qualitative, Mixed Methods, Psycho-Oncology, SES


Background: Patients with newly diagnosed lung cancer have one of the highest rates of psychosocial distress which may be reduced by identifying factors associated with psychosocial distress. This dissertation examined the association of neighborhood-level Social Determinants of Health (SDOH) and delay in treatment initiation with psychosocial distress. It also qualitatively explored perceptions and practices of the lung cancer care team regarding psychosocial distress screening.

Methods: Sociodemographic, clinical, and SDOH data of patients newly diagnosed with lung cancer between 2017 and 2021 was analyzed via logistic regression. Thematic analysis was done for interviews conducted with the lung cancer care team.

Results: SDOH and delay in treatment were not significantly associated with psychosocial distress. However, a high deprivation level of SDOH was associated with delay in treatment initiation. Qualitatively, four principal themes emerged: (1) Timing and frequency of screening: Multiple screenings at different time points may be more effective; (2) Training needs: All staff would benefit from training; (3) Staffing needs: More psychologists and social workers are needed to address identified patient psychosocial distress and; (4) Opportunity for holistic patient care: Consistent communication of distress screening information to physicians and surgeons may enhance a holistic care model for patients.

Conclusions: The lung cancer care team valued psychosocial distress screening and identified opportunities for improving screening processes. The finding of association of high deprivation level of SDOH with greater delay in treatment initiation suggests that targeted interventions to reduce delay in treatment initiation, focusing on economically marginalized groups may be warranted.



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