Doctoral Dissertation Research: Knowledge, Practice, and Clinical Experiences of Oncology

随着癌症等慢性疾病开始主导对全球健康和发展目标的威胁，提高我们对如何在非西方、低资源环境中实施生物医学计划的理解至关重要。人类学内部的研究一再表明，医疗很少在新的背景下不变地实施，生物医学系统适应当地的条件和信仰。通过对肿瘤学实践实施的仔细检查，该项目探索了癌症护理是如何受到技术、基础设施、经济、发展、医疗实践和文化信仰差异的影响的。通过更好地了解这些力量影响癌症护理的方式，该项目有可能为改进生物医学和肿瘤学的开发实践提供见解。此外，从这一具体案例研究中吸取的经验教训可以卓有成效地推广，以改进更广泛的生物医学和发展实践，包括在实施非传染性疾病护理系统的其他案例中使用。因此，随着全球卫生界开始关注慢性病问题，这个项目有可能为改善生物医学实践、培训和可持续基础设施的发展提供具体、可行的建议。丽贝卡·亨德森在佛罗里达大学的阿德里安·斯特朗博士的指导下，将调查癌症的知识、技术和治疗方案是如何在临床环境中创建和实施的，目的是了解生物医学在传播过程中是如何转变的。这项研究将在海地首都太子港的几个主要癌症研究中心以及更多农村地区的中心进行。使用定性的方法，这个项目将捕捉临床医生、患者和家庭在遇到肿瘤学时的观点。它将使用参与者观察来记录医院和卫生中心以及实验室和成像中心等诊断中心的活动。它还将对患者、他们的家人和从事他们护理的临床医生进行半结构化访谈，以获取当地对癌症、癌症治疗和疾病过程的了解。口述病史将有助于更好地了解过去十年癌症护理的发展。所有访谈和实地笔记都将使用基于扎根理论的迭代归纳方法进行主题编码。最后，将在临床中心对医疗记录进行审查，以更全面地描述肿瘤护理随时间的变化，并更好地了解这些因素对患者结果的影响。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。

As chronic diseases, such as cancer, begin to dominate the landscape of threats to global health and development targets, it is of vital importance to improve our understanding of how to implement biomedical programs in non-Western, low resource environments. Research from within anthropology has repeatedly shown medical treatments are rarely implemented in a new context unchanged, and that biomedical systems adapt to local conditions and beliefs. Through a careful examination of implementation of oncology practice, this project explores the ways that care for cancer is shaped by differences in technology, infrastructure, economics, development, medical practice, and cultural beliefs. By gaining a better understanding of the ways that these forces impact care for cancer, this project has the potential to yield insights for improvement in biomedical and development practice in oncology. Further, the lessons learned from this specific case study may be fruitfully extended to improve biomedical and development practice more broadly, including use in other cases of implementation of systems of care for non-infectious diseases. Thus, as the global health community begins to pivot towards the problems of chronic illness, this project has the potential to yield concrete, actionable recommendations for improving biomedical practice, training, and the development of sustainable infrastructure in this context.Rebecca Henderson, under the supervision of Dr. Adrienne Strong of the University of Florida, will investigate how knowledge, technology, and treatment protocols of cancer are created an enacted in clinical settings, with the aim of understanding how biomedicine is transformed as it travels. This research will be conducted in several of the key cancer research centers in Haiti in the capital city of Port-au-Prince, as well as those in more rural areas. Using a qualitative approach, this project will capture the perspectives of clinicians, patients, and families as they encounter oncology. It will employ participant observation in order to document activities in hospitals and health centers, as well as centers of diagnosis such as laboratories and imaging centers. It will also employ semi-structured interviews with patients, their families, and the clinicians engaged in their care in order to capture local understandings of cancer, cancer treatment, and disease course. Oral histories will allow for an improved understanding of the development of cancer care over the last decade. All interviews and fieldnotes will be thematically coded using an iterative, inductive methodology based on grounded-theory. Finally, a review of medical records will be conducted at clinical centers in order to more fully describe changes in oncological care over time, as well as to better understand the effect of these factors on patient outcomes.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.