1. State your health outcome of interest. (It could be the one you used for week #2 or another one.) Pick two key behaviors that are important factors leading to your health outcome. Explain the importance of these behaviors either for etiology, prevention, or intervention. (If none of the behaviors in the readings are important for your health outcome, suggest another behavior that is.)
My research is focused on integration of palliative care with pediatric oncology care and improving communication between providers, seriously ill patients, and their families. The behavior that seems most apparent to me is acceptance of new or unfamiliar medical interventions. Although pediatric palliative care is not necessarily new, the number of ill children with access to palliative care services has increased significantly in recent years. Some physicians have been hesitant to their patients to palliative care services, so many people are unfamiliar with palliative care. And, few people have been exposed to sick children prior to their own child’s illness. These factors (and probably others) combine to make palliative care not simply unfamiliar, but feel very new to patients. Many patients of lower SES have a distrust of the healthcare system, which adds another layer to already sensitive conversations and interventions regarding a child’s illness or end of life.
Another behavior that impacts my area of interest is parental employment. Having a sick child is incredibly demanding, both of finances and time. Patients from lower SES are more likely to have parents who are underemployed or unemployed. These parents often have to work long, inconsistent, or unpredictable hours, and they are more likely to have jobs without the flexibility needed to remain at the patient’s bedside. This results in multiple care givers with varying degrees of understanding participating in the patient’s care, and significantly effects the ability of providers to communicate with families.
2. Describe how you would study the role of one of the behaviors described for question #1 and your health outcome of interest. Incorporate a social factor (e.g. race/ethnicity, social exclusion, stress) in the study approach.
One goal of palliative care is to relieve stress associated with chronic illness in patients, caregivers, and families. It would be interesting to study the relationship between employment demands on caregivers and the stress of patients and caregivers. There are many validated inventories for evaluating stress in seriously ill people of different ages and caregivers. I can envision designing a brief survey of the employment status and demands on a child’s caregivers and administering this survey along with stress inventories periodically and longitudinally throughout a child’s illness to assess how work and its demands affect a child’s treatment course.
3. If key health behaviors (e.g. smoking, exercise, nutritious diet) are strongly influenced by neighborhood, income, and/or education, do we need to continue to study how these behaviors influence health outcomes? Why or why not?
I think we should continue to study how these behaviors influence health outcomes. Although these behaviors are influenced by neighborhood, income, and education, it is possible if not likely, that neighborhood, income, and education could influence health behaviors and thus health outcomes. Socioeconomic factors can be modifiable, and some are more easily modified than others. Itis not unreasonable to think that some socioeconomic factors might be more easily modified than attempting to modify behaviors alone. If modifying socioeconomic factors can facilitate behavioral change leading to improved health outcomes, it could lead to benefit extending beyond the individuals directly receiving the benefit, both generationally and in the present community.