Factors that contribute to disparities in time to acute leukemia diagnosis in young people: an in depth qualitative interview study.

BACKGROUND: Racial and ethnic disparities in outcomes for Black and Hispanic children with acute leukemia have been well documented, however little is known about the determinants of diagnostic delays in pediatric leukemia in the United States. The primary objective of this study is to identify factors contributing to delays preceding a pediatric leukemia diagnosis. METHODS: This qualitative study utilized in-depth semi-structured interviews. Parents and/or patients within two years of receiving a new acute leukemia diagnosis were asked to reflect upon their family's experiences preceding the patient's diagnosis. Subjects were purposively sampled for maximum variation in race, ethnicity, income, and language. Interviews were analyzed using inductive theory-building and the constant comparative method to understand the process of diagnosis. Chart review was conducted to complement qualitative data. RESULTS: Thirty-two interviews were conducted with a diverse population of English and Spanish speaking participants from two tertiary care pediatric cancer centers. Parents reported feeling frustrated when their intuition conflicted with providers' management decisions. Many felt laboratory testing was not performed soon enough. Additional contributors to delays included misattribution of vague symptoms to more common diagnoses, difficulties in obtaining appointments, and financial disincentives to seek urgent or emergent care. Reports of difficulty obtaining timely appointments and financial concerns were disproportionately raised among low-income Black and Hispanic participants. Comparatively, parents with prior healthcare experiences felt better able to navigate the system and advocate for additional testing at symptom onset. CONCLUSIONS: While there are disease-related factors contributing to delays in diagnosis, it is important to recognize there are multiple non-disease-related factors that also contribute to delays. Evidence-based approaches to reduce outcome disparities in pediatric cancer likely need to start in the primary care setting where timeliness of diagnosis can be addressed.

The Relationship between Plastic Surgery Residency Instagram Characteristics and Doximity Rank.

Social media provides unique insight into the facilities, personnel, and culture of plastic surgery residency programs. Applicants can gain a more holistic view of programs based on their social media accounts. This study aims to evaluate the relationship between the popularity of a program's Instagram account and the program's Doximity ranking and to investigate the factors which contribute to greater viewership, with a special focus on diversity. Methods: Using Doximity's 2021-2022 Residency Navigator, a list of all integrated plastic surgery residency programs was obtained, and their social media accounts were documented. Instagram accounts were analyzed for metrics, post content, and website links. A 15-month period of posts was analyzed, then grouped into eight categories. Diversity was assessed using average Fitzpatrick skin type for each post containing photographs of people. Results: Of the 88 programs, 85 (96.6%) had an Instagram account at the time of analysis. Analysis of Instagram post content found that personnel and social function posts had significantly more likes than other categories. Posts with average Fitzpatrick type greater than or equal to III also had significantly more likes. Linear regression demonstrated a positive relationship between higher Doximity rank and number of followers; however, there was no clear relationship between rank and posts per week or engagement score. Conclusions: Plastic surgery social media accounts may make a positive impact on followers. It is important to understand the factors that can increase engagement and broaden viewership. Tailoring posts based on content popularity and highlighting diversity may help to accomplish these goals.