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Principal Investigator: Patricia G. Buzelli
Organization: DUKE UNIVERSITY
Fiscal Year: 2024
Award: $48,974
Funding agency: National Institute of Nursing Research
ABSTRACT
Latinx children in the United States (US) are more than 50% more likely to die of their cancer diagnosis in
comparison to non-Latinx White children due to systemic inequities which arise from adverse social
determinants of health (SDOH). Latinx families in the US face several adverse SDOH including discrimination
based on race/ethnicity, language, or culture, and inequitable social structures that limit their access to various
resources, all of which affects their child’s risk of developing and dying from cancer and aggravate
bereavement and grief inequities among family members, including depression, anxiety, post-traumatic stress
disorder, and social isolation. Despite higher cancer mortality, there remains a striking under representation of
Latinx populations in the study of pediatric bereavement. Further, the identification of resiliency factors has
remained undiscovered because the experience of cancer loss in Latinx populations has not yet been explored
from a culturally and contextually grounded, strength-based perspective. The overall purpose of this study is
to explore the culturally grounded experiences and grief outcomes of Latinx families in the US who are living
through the loss of a child to cancer. This study will utilize a modified version of the Center for Latino
Adolescent and Family Health Framework of SDOH Mechanisms, that has been integrated with culturally
grounded grief concepts in a mixed methods design that integrates data from validated measures representing
the framework’s domains (n=60), with qualitative descriptive data from individual interviews (n=~20) with the
deceased child’s primary caregiver. The aims are to: Aim 1: To examine relationships among the domains of
the SDOH mechanisms of Latinx families in the US who are living through the loss of a child to cancer
including SDOH capital (healthcare access), SDOH processes (acculturation stress), contextual exposures
(social meaning-making), resiliency factors (Latinx culture) and critical grief outcomes (coping, mental health,
post-traumatic growth, continuing bonds) through self-reported measures. Aim 2: To elucidate the experiences
of Latinx families in the US who are living through the loss of a child to cancer in the context of SDOH
mechanisms (SDOH capital, SDOH processes, contextual exposures, resiliency factors, critical grief
outcomes) through in-depth, individual semi-structured qualitative interviews. Aim 3: To develop a
comprehensive understanding of how multilevel resiliency factors across the domains of SDOH mechanisms
(healthcare access, acculturation stress, social meaning-making, culture, critical grief outcomes) influence
adaptive grief outcomes among Latinx families in the US after the loss of a child to cancer by integrating data
from self-reported measures and qualitative interviews. The findings will enhance the understanding of the
mechanisms of inequities in pediatric oncology bereavement outcomes that can affect Latinx bereaved families
and inform the development of culturally grounded interventions to address them.
Terms: <0-11 years old><Acculturation><Address><Affect><Affective><Anxiety><Application Context><Bereavement><Cancers><Capital><Cessation of life><Child><Child Youth><Childhood><Childhood Cancers><Children (0-21)><Cultural Assimilation><Data><Death><Development><Elements><Ethnic Origin><Ethnicity><Face><Family><Family Health><Family health status><Family member><Foundations><Future><Grief><Grief reaction><Health><Health Inequity><Individual><Inequalities in Health><Inequities in Health><Inequity><Intervention><Intervention Strategies><Interview><Language><Latine><Latino><Latinx><Latinx group><Latinx individual><Latinx people><Latinx population><Lived experience><Lived experiences><Malignant Childhood Neoplasm><Malignant Childhood Tumor><Malignant Neoplasms><Malignant Pediatric Neoplasm><Malignant Pediatric Tumor><Malignant Tumor><Malignant childhood cancer><Measurement><Measures><Mental Depression><Mental Health><Mental Hygiene><Methodology><Methods><National Institute of Nursing Research><Outcome><PTSD><Parents><Pathology><Patient Self-Report><Pediatric Oncology><Personal Satisfaction><Population><Population Heterogeneity><Population Intervention><Post-Traumatic Neuroses><Post-Traumatic Stress Disorders><Post-traumatic growth><Posttraumatic Neuroses><Posttraumatic growth><Process><Psychological Health><Reaction><Reporting><Research><Research Resources><Resources><Risk><Self-Report><Shapes><Social isolation><Stress><Structure><United States><access to health care><access to healthcare><accessibility of health care><accessibility to health care><accessibility to healthcare><adolescent health><cancer diagnosis><cancer in a child><cancer in children><child with cancer><childhood malignancy><contextual factors><coping><data integration><depression><design><designing><developmental><direct application><discrimination based on race><discrimination due to race><diverse populations><experience><faces><facial><health care access><health care availability><health care service access><health care service availability><health equity><health equity promotion><health inequalities><healthcare access><healthcare accessibility><healthcare availability><healthcare service access><healthcare service availability><heterogeneous population><interventional strategy><kids><loved ones><malignancy><mortality><neoplasm/cancer><parent><pediatric><pediatric cancer><pediatric malignancy><population based intervention><population diversity><population specific intervention><post-trauma stress disorder><posttrauma stress disorder><primary care giver><primary caregiver><promote health equity><psychological distress><race discrimination><race-based discrimination><race-related discrimination><racial discrimination><resilience><resilience factor><resiliency factor><resilient><response><social><social factors><social health determinants><social norm><social structural><social structure><socio-structural><sociostructural><traumatic neurosis><well-being><wellbeing><youngster>