Health Inequalities in Access to Care among Latino Patients

该奖项是美国国家科学基金会社会、行为和经济科学（SBE）博士后研究奖学金（SPRF）项目和SBE社会心理学项目的一部分。SPRF计划的目标是为学术界、工业界或私营部门和政府的科学事业准备有前途的早期职业博士级科学家。SPRF奖励包括在知名科学家的赞助下进行为期两年的培训，并鼓励博士后进行独立研究。美国国家科学基金会寻求促进科学界各阶层的科学家，包括那些未被充分代表的群体的科学家，参与其研究项目和活动；博士后阶段被认为是实现这一目标的一个重要的专业发展阶段。每个博士后必须解决各自学科领域的重要科学问题。在德克萨斯大学奥斯汀分校的马克·海沃德博士的赞助下，这个博士后奖学金奖支持一位早期职业科学家调查社会不平等对拉丁裔患者晚期癌症护理的影响。跨多个学科的研究表明，拉丁裔患者缺乏获得高质量癌症治疗的机会，比其他种族和族裔群体更不可能获得标准的临终关怀，并且由于额外的社会经济挑战而面临持续的健康不平等。然而，我们对这些社会和健康差异如何影响求医行为知之甚少。此外，我们对患者如何试图克服结构性障碍并在医疗保健系统中导航所知甚少。该项目可以通过提供决策者和社区组织可以用来解决拉丁裔社区卫生不平等问题的关键见解来产生社会效益。本研究探讨了拉丁裔癌症患者及其家庭成员访问医疗设施，浏览医疗机构，尝试治疗癌症和计划死亡的过程。本项目采用多方法设计，包括民族志观察、定性地理成像系统（QGIS）、“同行”和深度访谈。具体来说，数据收集包括记录和绘制参与者获得医疗服务的物理路线，观察参与者如何应对医疗官僚机构，检查参与者如何与亲人谈论死亡（或忽略这个话题），并分析患者和家属如何在考虑到可怕的医疗环境的情况下就未来目标达成某种共识。多方法定性研究设计产生各种类型的数据，从而允许进行细粒度分析，这反过来有助于追踪再现健康不平等的不同机制以及患者对经历这种不平等的反应方式。该项目通过揭示健康不平等影响拉丁裔患者晚期癌症护理的方式，为现有知识做出了新的贡献。研究种族/民族不平等如何影响医疗保健获取和患者用于浏览医疗机构的资源（物质和社会），可以帮助制定有助于减少健康差距的政策，并支持患者已经成功使用的求医策略。本研究的发现也可以为未来想要研究种族/民族与健康不平等之间关系以及社会经济因素对医疗保健获取的影响的研究人员提供新的见解。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

This award was provided as part of NSF's Social, Behavioral and Economic Sciences (SBE) Postdoctoral Research Fellowships (SPRF) program and SBE's Social Psychology program. The goal of the SPRF program is to prepare promising, early career doctoral-level scientists for scientific careers in academia, industry or private sector, and government. SPRF awards involve two years of training under the sponsorship of established scientists and encourage Postdoctoral Fellows to perform independent research. NSF seeks to promote the participation of scientists from all segments of the scientific community, including those from underrepresented groups, in its research programs and activities; the postdoctoral period is considered to be an important level of professional development in attaining this goal. Each Postdoctoral Fellow must address important scientific questions that advance their respective disciplinary fields. Under the sponsorship of Dr. Mark Hayward at The University of Texas at Austin, this postdoctoral fellowship award supports an early career scientist investigating the influence that social inequalities exert on terminal cancer care for Latino patients. Research across multiple disciplines shows that Latino patients lack access to high-quality cancer care, are less likely to receive standard end-of-life care than other racial and ethnic groups, and face persistent health inequalities due to additional socioeconomic challenges. Yet, we know far less about how these social and health disparities influence care-seeking behavior. Additionally, we know even less about how patients attempt to overcome structural barriers and navigate the healthcare system. This project can produce societal benefits by providing key insights policymakers and community organizations can use to address health inequalities in Latino communities.This research explores the processes by which terminal Latino cancer patients and their family members access medical facilities, navigate healthcare institutions, attempt to treat the cancer, and plan for death. This project uses a multi-method design, which includes ethnographic observations, qualitative geographic imaging system (QGIS), "go alongs", and in-depth interviews. Specifically, data collection includes documenting and mapping the physical routes participants take to access care, observing how participants navigate healthcare bureaucracies, examining how participants talk about death (or ignore the subject) with loved ones, and analyzing how patients and family members come to some sort of consensus about future goals considering the dire medical circumstances. A multi-method qualitative research design generates various types of data, which allows for fine grain analyses, which in turn help trace the different mechanisms through which health inequalities are reproduced and the ways patients respond to experiencing such inequalities. This project makes novel contributions to existing knowledge by uncovering the ways health inequalities shape terminal cancer care for Latino patients. Studying how racial/ethnic inequalities influence healthcare access and the resources (both material and social) that patients use to navigate healthcare institutions can help generate policies that help lessen health disparities and support the care-seeking strategies patients are already successfully using. Findings from this study can also provide new insights for future researchers that want to study the relationship between race/ethnicity and health inequalities and the influence that socioeconomic factors have of healthcare access.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.