Dr Lena Winestone Outlines Barriers to Care and Disparities Among Children With Leukemia

Financial barriers and perceived implicit biases were both barriers that families of children with acute leukemia raised regarding access to care issues that might have delayed diagnosis, said Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco.

What did the interviews you conducted reveal about access to care and how it might influence disparities among children with acute leukemia?
Yeah, so in the interviews that we conducted, families identified a variety of different barriers to care. But some of the ones that really jumped out to us were the financial barriers. So, several families said that they either took longer to go to their primary care doctor, or that [financial costs] was involved in the decision making about whether they went to the primary care doctor versus an urgent care versus an emergency room. Their type of insurance and the co-pays associated with that really determined how they chose to navigate the health system and get the care that they ultimately receive. And we think that that probably has implications for the timeliness of their diagnosis.

In addition, there were some suggestions of sort of interactions between the provider and patient that were less than optimal. And we're sort of continuing to work to tease apart whether that could be related to some racial implicit bias. And, you know, some patients at least felt as if their provider treated them differently, either because of their age or because of their race, or because of their ethnicity, or because of language barriers. And so those pieces are ongoing investigation to understand exactly what barriers particularly our impoverished patients and our minority patients face.
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