1. Write a brief paragraph discussing what social determinants are most relevant to your area of research and why. Consider both structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances, as described in the WHO reading. Explain why you chose the factors (might use Braveman article from last week to provide justification. The association could be reported in published research or it could be your hypothesized relationship. Consider whether how these factors might function over the lifecourse and/or intergenerationally.
In the intersection of the fields of pediatric palliative care and hematologic/oncologic research, the most apparent social determinants at play are race and socioeconomic position. Obviously, by nature of children, we are dealing with a group with less power than adults and who have varying levels of autonomy. Thus, our work always has to take place in the context of a household. The parents’ or guardians’ socioeconomic position (including occupation, net household material resources, and educational level) affect the patient’s and family’s availability to gain understanding of the child’s care and affects adherence to treatment or investigational regimens. We frequently encounter patients and families with cultural and racial backgrounds that impact their views of illness, suffering, death and dying, and care provided by the medical system. These views impact not only the clinical care these patients receive, but also (and sometimes to a greater extent) their willingness to participate as research subjects. The social determinants at play are abundant, but these stand out particularly to me from my personal experience as the factors I described seem particularly impactful on a patient’s or family’s openness to receiving palliative care interventions and being included in investigational efforts.
2. Write a brief paragraph describing the extent to which an socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework?
Work has been done evaluating intensity of end of life care received by critically ill children by race/ethnicity, age, and neighborhood income, and a few studies have evaluated the impact of different socioeconomic factors on palliative care interventions and end of life outcomes in children with cancer or undergoing bone marrow transplantation. These studies consistently find socioeconomic and racial/ethnic disparities. The field of pediatric palliative care research is relatively new, so there are many opportunities to improve the understanding of disparities. Much of the work published thus far has been through database review of data collected for other purposes. Patients’ and families’ perceptions of palliative care and end of life care are significant contributors to the supportive and end of life care that patients receive. Little work has been done to evaluate patients’ and families’ perceptions directly, so this would be a potential area of improvement.