1. After reading the article by Thomas et al., comment on where your research, or your research interests, fit into the generational framework for health disparities research. If your work is 1st or 2nd generation, comment on how your work could lead in the future to 3rd or 4th generation work. If your work is 3rd or 4th generation, comment on what 1rst and 2nd generation work was necessary as a foundation for your current work (or current interests).
Most of the research in oncology and palliative care that I have seen is first or second generation. In pediatric oncology especially, most of the work is first generation. I have seen more second generation work in palliative care, but the implementation of pediatric palliative care varies so much from site to site. So even when second generation work is done, there are places where very few patients have access to providers with significant palliative care training. I think that an important goal, and an exciting opportunity, in palliative care is to increase the training that all providers receive, and to target those providers equitably. So, concurrently while doing third generation work to try to eliminate identified disparities, we can try to increase access to palliative care without widening disparities.
2. The barbershop hypertension intervention, while essentially a clinical services intervention operating at either the fence or safety-net level as described by Jones, has some engagement with the social determinants of health. Interventions like that described in the Gottleib article are designed to mitigate the impact of social determinants. How could you apply one of these two types of interventions to your area of research? Propose one or two interventions that engage with social determinants on some level.
In pediatric oncology, we see worse outcomes for Black and Hispanic patients with leukemia compared to White patients. Part of this is disparity is due to the intensity and duration of leukemia therapy, which requires at least 2 years of multimodal therapy including inpatient chemotherapy, outpatient IV chemotherapy, oral chemotherapy given at home, and intrathecal chemotherapy which sometimes requires anesthesia. The therapy is intense and difficult for the most privileged and medically literate patients, but is much more challenging for patients facing some sort of disparity. While social workers are actively involved in the care of these patients, their resources are often stretched thin. Many patients struggle with transportation to and from appointments, with financial resources to pay for chemotherapy and supportive medications, and with maintaining employment during this long therapy. It would be interesting to study if a structured needs assessment, similar to that from the Gottleib article, could be implemented to help identify patients most in need of assistance and then resources could be better allocated to eliminate these disparities.