Health Inequalities in Access to Care among Latino Patients

该奖项是NSF社会、行为和经济科学(SBE)博士后研究奖学金(SPRF)计划和SBE社会心理学计划的一部分。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职业生涯培养有前途的、早期职业博士水平的科学家。SPRF奖项包括在知名科学家的赞助下进行两年的培训，并鼓励博士后研究员进行独立研究。国家科学基金会致力于促进科学界所有阶层的科学家参与其研究方案和活动，包括那些来自代表性不足的群体的科学家；博士后阶段被认为是实现这一目标的专业发展的一个重要水平。每个博士后研究员都必须解决推动各自学科领域向前发展的重要科学问题。在德克萨斯大学奥斯汀分校马克·海沃德博士的赞助下，这一博士后奖学金奖项支持一位早期职业科学家，他研究了社会不平等对拉丁裔晚期癌症患者护理的影响。跨多学科的研究表明，拉美裔患者缺乏获得高质量癌症护理的机会，与其他种族和族裔群体相比，他们不太可能接受标准的临终护理，而且由于额外的社会经济挑战，他们面临持续的健康不平等。然而，我们对这些社会和健康差距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体系中导航的了解更少。这个项目可以通过提供关键的见解来产生社会效益，政策制定者和社区组织可以用来解决拉丁裔社区的健康不平等问题。这项研究探索了晚期拉丁裔癌症患者及其家人访问医疗机构、导航医疗机构、尝试治疗癌症和计划死亡的过程。该项目采用了多方法设计，包括人种学观察、定性地理成像系统(QGIS)、“走下去”和深度访谈。具体地说，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，观察参与者如何驾驭医疗机构，检查参与者如何与亲人谈论死亡(或忽视主题)，以及分析考虑到可怕的医疗环境，患者和家人如何就未来目标达成某种共识。多方法定性研究设计生成各种类型的数据，允许进行细粒度分析，这反过来又有助于跟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美裔晚期癌症护理的方式，对现有知识做出了新的贡献。研究种族/民族不平等如何影响患者获得医疗保健的机会以及患者在医疗机构中使用的资源(物质和社会资源)，有助于制定有助于缩小健康差距的政策，并支持患者已经成功使用的求医策略。这项研究的结果也可以为未来的研究人员提供新的见解，这些研究人员希望研究种族/民族与健康不平等之间的关系，以及社会经济因素对医疗保健获得的影响。这一奖项反映了NSF的法定使命，并通过使用基金会的智力优势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.