Reducing Inequities through Systematic Social needs Screening in Pediatric Palliative Care
Parents caregivers living in poverty experience higher levels of severe distress during their child’s cancer treatment compared to parents without poverty exposure, and parent distress worsens in advanced pediatric cancer. Nearly 1 in 3 families of children with cancer experience unmet social needs at the time of diagnosis and these needs increase over time despite care at well-resourced centers. In my postdoctoral work in upfront cancer, I demonstrated the independent association of unmet social needs with severe psychological distress among parents of children with leukemia. We additionally demonstrated that 1) upfront cancer social needs screening is feasible and 2) targeting social needs through direct intervention is acceptable to parents at this time. However, there are no evidence-based interventions focused on identifying or addressing social needs in pediatric advanced cancer. A significant proportion of children with advanced cancer are referred to specialty pediatric palliative care (PPC) which represents a consistent and unique opportunity to screen for and address family social needs, and in turn improve parent caregiver distress outcomes.I aim to translate my postdoctoral findings to the PPC setting at Dana-Farber Cancer Institute/Boston Children’s Hospital through the following Aims: 1a) Quantitatively characterize parent-reported social needs in advanced cancer through systematic evaluation at initial PPC consult (N=50) using a previously established survey; 1b) Qualitatively identify parent priorities for a social needs intervention using focus groups among a subcohort of Aim 1a parents (3 focus groups of N=5 parents); and 2) Co-develop a social needs intervention for pediatric advanced cancer to reduce outcome disparities with a 2a) parent advisory board and 2b) health equity scientific advisory board. Completion of these aims and career development goals will lay the groundwork for an NIH K application to evaluate the intervention among PPC families of children with advanced cancer to reduce inequities in parental distress.
Puja Umaretiya, MD, is an Instructor of Pediatrics at Harvard Medical School and an attending physician at the Dana-Farber/Boston Children's Cancer and Blood Disorders Center. She completed pediatric residency in the Boston Combined Residency Program (Boston Children’s Hospital and Boston Medical Center) and subsequently completed fellowships in pediatric palliative care and pediatric hematology/oncology at Dana-Farber/Boston Children’s Hospital. Her research focuses on identifying and addressing social determinants of health that drive inequities experienced by children and parents during advanced cancer care. Ultimately, she aims to enhance the well-being of historically marginalized children living with cancer and their families. Dr. Umaretiya will be an incoming Assistant Professor of Pediatrics at UT Southwestern beginning in September 2023.