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Wilson J, McGiffin JN, Smith M, Garduño-Ortega O, Talis E, Zarate A, Jenkins N, Rath JF, Bushnik T. Comparison of Informational and Educational Resource Provision for Individuals Living With Traumatic Brain Injury Based on Language, Nativity, and Neighborhood. J Head Trauma Rehabil 2023; 38:175-183. [PMID: 36730859 DOI: 10.1097/htr.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine a resource provision program for individuals living with moderate-to-severe traumatic brain injury (TBI), using a comparison of the resources provided across social differences of language, nativity, and neighborhood. SETTING The Rusk Rehabilitation TBI Model System (RRTBIMS) collects data longitudinally on individuals from their associated private and public hospitals, located in New York City. PARTICIPANTS A total of 143 individuals with TBI or their family members. DESIGN An observational study of relative frequency of resource provision across variables of language, nativity, and neighborhood, using related-samples nonparametric analyses via Cochran's Q test. MAIN MEASURES Variables examined were language, place of birth, residence classification as medically underserved area/population (MUA), and resource categories. RESULTS Results indicate that US-born persons with TBI and those living in medically underserved communities are provided more resources than those who are born outside the United States or reside in communities identified as adequately medically served. Language was not found to be a factor. CONCLUSION Lessons learned from this research support the development of this resource provision program, as well as guide future programs addressing the gaps in health information resources for groups negatively impacted by social determinants of health (SDoH). An approach with immigrant participants should take steps to elicit questions and requests, or offer resources explicitly. We recommend research looking at what interpreter strategies are most effective and research on SDoH in relation to the dynamic interaction of variables in the neighborhood setting.
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Affiliation(s)
- Judith Wilson
- Department of Occupational Therapy, Bellevue Hospital/NYU, New York, New York (Ms Wilson); and Rusk Rehabilitation, NYU Langone Health, New York, New York (Drs McGiffin, Talis, Rath, and Bushnik, Mss Smith, Garduño-Ortega, and Jenkins and Mr Zarate)
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Garduño-Ortega O, Li H, Smith M, Yao L, Wilson J, Zarate A, Bushnik T. Assessment of the individual and compounding effects of marginalization factors on injury severity, discharge location, recovery, and employment outcomes at 1 year after traumatic brain injury. Front Neurol 2022; 13:942001. [PMID: 36090882 PMCID: PMC9462705 DOI: 10.3389/fneur.2022.942001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of this study is to examine the effect of eight distinct marginalized group memberships and explore their compounding effect on injury severity, recovery, discharge location, and employment outcomes 1-year after traumatic brain injury (TBI). Methods Individuals with medically confirmed, complicated mild-severe TBI (N = 300) requiring inpatient rehabilitation care between the ages of 18 and 65 were recruited at two urban (public and private) health systems between 2013 and 2019. Data were collected from self-report and medical record abstraction. Marginalized group membership (MGM) includes racial and ethnic minority status, less than a high school diploma/GED, limited English proficiency, substance abuse, homelessness, psychiatric hospitalizations, psychiatric disorders, and incarceration history. Membership in four or more of these groups signifies high MGM. In addition, these factors were explored individually. Unadjusted and adjusted linear and logistic regressions and Kruskal–Wallis tests were used to assess the associations of interest in RStudio. Results After adjusting for age, sex, and cause of injury, compared to TBI patients with low MGM, those with high MGM experience significantly longer post-traumatic amnesia (95% CI = 2.70, 16.50; p = 0.007) and are significantly more likely to have a severe TBI (per the Glasgow-Coma Scale) (95% CI = 1.70, 6.10; p ≤ 0.001) than a complicated mild-moderate injury. Individuals with high MGM also are significantly less likely to be engaged in competitive paid employment 1 year after injury (95% CI = 2.40, 23.40; p = 0.001). Patients with high MGM are less likely to be discharged to the community compared to patients with low MGM, but this association was not significant (95% CI = 0.36, 1.16; p = 0.141). However, when assessing MGMs in isolation, certain associations were not significant in unadjusted or adjusted models. Conclusion This exploratory study's findings reveal that when four or more marginalization factors intersect, there is a compounding negative association with TBI severity, recovery, and employment outcomes. No significant association was found between high MGM and discharge location. When studied separately, individual MGMs had varying effects. Studying marginalization factors affecting individuals with TBI has critical clinical and social implications. These findings underline the importance of addressing multidimensional factors concurrent with TBI recovery, as the long-term effects of TBI can place additional burdens on individuals and their economic stability.
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Affiliation(s)
- Olga Garduño-Ortega
- Research Department, Rusk Rehabilitation, Grossman School of Medicine, NYU Langone Health, New York, NY, United States
- *Correspondence: Olga Garduño-Ortega
| | - Huihui Li
- Research Department, Rusk Rehabilitation, Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Michelle Smith
- Research Department, Rusk Rehabilitation, Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Lanqiu Yao
- Department of Population Health, Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Judith Wilson
- Occupational Therapy Department, Bellevue Hospital, Health and Hospitals, New York, NY, United States
| | - Alejandro Zarate
- Research Department, Rusk Rehabilitation, Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Tamara Bushnik
- Research Department, Rusk Rehabilitation, Grossman School of Medicine, NYU Langone Health, New York, NY, United States
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Garduño-Ortega O, Morales-Cruz J, Hunter-Hernández M, Gany F, Costas-Muñiz R. Spiritual Well-Being, Depression, and Quality of Life Among Latina Breast Cancer Survivors. J Relig Health 2021; 60:1895-1907. [PMID: 33439398 PMCID: PMC8358984 DOI: 10.1007/s10943-020-01147-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 05/11/2023]
Abstract
This study explores the relationship between spiritual well-being (SWB) (meaning/peace & faith), depression, and quality of life (QOL). Cancer survivors often use their spirituality as a way of coping. Among a sample of 97 Latina breast cancer survivors (LBCS), SWB was assessed with the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale, QOL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G), and depression was measured with the Patient Health Questionnaire. Study findings revealed that SWB, specifically the meaning/peace factor, is the main predictor of an increase in QOL and a reduction in depression among LBCS.
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Affiliation(s)
- O Garduño-Ortega
- Department of Psychiatry & Behavioral Sciences, Immigrant Health & Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - J Morales-Cruz
- Center for Evaluation and Sociomedical Sciences, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - M Hunter-Hernández
- NYS Office for People With Developmental Disabilities, Tarrytown, NY, USA
| | - F Gany
- Department of Psychiatry & Behavioral Sciences, Immigrant Health & Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Costas-Muñiz
- Department of Psychiatry & Behavioral Sciences, Immigrant Health & Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Costas-Muñiz R, Garduño-Ortega O, Hunter-Hernández M, Morales J, Castro-Figueroa EM, Gany F. Barriers to Psychosocial Services Use For Latina Versus Non-Latina White Breast Cancer Survivors. Am J Psychother 2021; 74:13-21. [PMID: 33028079 PMCID: PMC8573900 DOI: 10.1176/appi.psychotherapy.20190036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aims of this study were to compare barriers to use of psychosocial services by Latina versus non-Latina white women who had been diagnosed as having breast cancer and to examine associations between the barriers and use of psychosocial services. METHODS A sample of 265 Latina and non-Latina white women who had received treatment in a comprehensive cancer center in New York City completed a mailed questionnaire. The questionnaire measured quality of life, interest in receiving help for psychological distress, psychosocial services use, and barriers to use of psychosocial services. Bivariate and adjusted logistic regression models were used to analyze the data. RESULTS More than half of the sample reported preferring to return to their normal routines, felt they could take care of their emotional problems themselves, and preferred to seek support from their family or friends. Latinas were more likely to seek counseling from a spiritual leader, to report that there were no counselors who spoke their language and understood their values or background, and to report that mental health services were too expensive. CONCLUSIONS It is crucial to address the barriers that contribute to health disparities and discrepancies in patient access to and use of psychosocial health care. These findings highlight the need to educate providers about patients' psychosocial needs, provide patients with information about the benefits of psychosocial services, normalize mental health service use, diminish stigma surrounding use of these services, and provide culturally and linguistically sensitive services for Latina patients.
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Affiliation(s)
- Rosario Costas-Muñiz
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 485 Lexington Avenue, 2nd floor, New York, NY, USA 10017
- Weill Cornell Medica College
| | - Olga Garduño-Ortega
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 485 Lexington Avenue, 2nd floor, New York, NY, USA 10017
| | - Migda Hunter-Hernández
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 485 Lexington Avenue, 2nd floor, New York, NY, USA 10017
| | - Jennifer Morales
- School of Behavioral and Brain Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
| | - Eida M. Castro-Figueroa
- School of Behavioral and Brain Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
- Department of Psychiatry, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
| | - Francesca Gany
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 485 Lexington Avenue, 2nd floor, New York, NY, USA 10017
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Costas-Muñiz R, Garduño-Ortega O, Torres-Blasco N, Castro-Figueroa E, Gany F. "Maintaining hope:" challenges in counseling latino patients with advanced cancer. J Psychosoc Oncol Res Pract 2020; 2:e028. [PMID: 33154993 PMCID: PMC7597581 DOI: 10.1097/or9.0000000000000028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Latino cancer patients are at risk of poor psychological adjustment. Therapeutic effectiveness in treating Latino cancer patients with advanced cancer requires managing distress, therapeutic skill, and cultural competency. This mixed-methods study explored mental health providers' perceptions of the challenging aspects of counseling and caring for Latino patients with advanced cancer. METHODS Mental health providers providing services to Latino or Hispanic cancer patients received an emailed web-based survey with open- and closed-ended questions. Providers included psychiatrists, psychologists, social workers, counselors, and other mental health professionals. We invited 154 providers to participate from July 2015 to January 2017. One hundred and four accessed the survey, and 66 eligible providers responded, for a response rate of 43%. Analyses were used to explore whether clinical experience factors and training characteristics were associated with perceiving conversations about cancer (diagnosis, prognosis, and end-of-life) as challenging. Second, the challenging aspects of these conversations were explored qualitatively. Four independent coders coded responses; an inductive content analysis was utilized to analyze the data. RESULTS Mental health providers describe encountering many challenges in their therapeutic discussions with Latino cancer patients. CONCLUSIONS It is imperative to understand the factors associated with the perceived difficulty of these conversations, as well as the characteristics of these conversations, to develop culturally sensitive interventions and programs for patients and training interventions for providers.
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Affiliation(s)
- Rosario Costas-Muñiz
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Olga Garduño-Ortega
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Normarie Torres-Blasco
- Department of Psychiatry and Human Behavior, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR
| | - Eida Castro-Figueroa
- Department of Psychiatry and Human Behavior, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR
| | - Francesca Gany
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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Pelto DJ, Ocampo A, Garduño-Ortega O, Barraza López CT, Macaluso F, Ramirez J, González J, Gany F. The Nutrition Benefits Participation Gap: Barriers to Uptake of SNAP and WIC Among Latinx American Immigrant Families. J Community Health 2020; 45:488-491. [PMID: 31630308 PMCID: PMC8238138 DOI: 10.1007/s10900-019-00765-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To examine nutrition benefit under-enrollment in Latinx American immigrant families, we administered a survey to 100 adults attending a NY Latinx American community serving organization. We used a logistic regression approach to analyze misinformation impact on enrollment, and examined non-enrollment explanations, among participants in whose families a child or pregnant or breastfeeding woman appeared SNAP- or WIC-eligible. Among households (N = 51) with ≥ 1 SNAP-eligible child, 49% had no child enrolled. Reasons included repercussion fears (e.g. payback obligation, military conscription, college aid ineligibility, child removal, non-citizen family member penalties), and logistical barriers. In multivariable regression models, having heard the rumor that SNAP/WIC participation makes unauthorized status family members vulnerable to being reported to the government was associated with an 85% lower enrollment rate (OR 0.15, CI 0.03, 0.94). Misinformation impedes nutrition benefit participation. A multi-level intervention is necessary to inform potential applicants and providers regarding eligibility criteria and erroneous rumors, along with an informed discussion of the risks versus benefits of using resources, especially as public charge criteria change.
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Affiliation(s)
- Debra J Pelto
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, Second Floor, New York, NY, 10017, USA
| | - Alex Ocampo
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, Second Floor, New York, NY, 10017, USA
| | - Olga Garduño-Ortega
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, Second Floor, New York, NY, 10017, USA
| | - Claudia Teresa Barraza López
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, Second Floor, New York, NY, 10017, USA
| | - Francesca Macaluso
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, Second Floor, New York, NY, 10017, USA
| | - Julia Ramirez
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, Second Floor, New York, NY, 10017, USA
| | - Javier González
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, Second Floor, New York, NY, 10017, USA
| | - Francesca Gany
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, Second Floor, New York, NY, 10017, USA.
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Torres-Blasco N, Castro-Figuero E, Garduño-Ortega O, Costas-Muñiz R. Cultural Adaptation and Open Pilot of Meaning-Centered Psychotherapy for Puerto Rican Patients with Advanced Cancer. ACTA ACUST UNITED AC 2020; 8:100-107. [PMID: 34532506 DOI: 10.11648/j.sjedu.20200804.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In Puerto Rico, cancer incidence increases significantly, and is accompanied with a greater risk of experiencing high levels of depressive symptoms, emotional distress, and reduced quality of life when compared to other minority ethnic groups. Studies suggest that interventions to attend distress in Latino patient population would benefit from including components that seek to improve patients' spiritual well-being. The purpose of this study is to identify the level of comprehension and acceptance of Meaning-Centered Psychotherapy (MCP) concepts. A mixed method design was conducted with in-depth interviews and open pilot data. A total of nine participants with advanced or metastatic cancer were sampled from an Oncology Clinic in the south of Puerto Rico. Six semi-structured interviews and six ethnographic notes with audiotape sessions were selected and transcribed. All material was analyzed, resulting in a sample of six semi-structured interview and six ethnographic note peer sessions. Patients showed low comprehension of the MCP concepts of meaning, the finite, and legacy. Patients showed low acceptance of death and its related concepts. They also reported high acceptance of integrating family members to their therapy. In order to tailor the intervention and improve comprehension, the content should include examples, shorter questions, and brief definitions. Additionally, there is a need to address death and its related concepts in end of life.
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Affiliation(s)
- Normarie Torres-Blasco
- Ponce Research Institute, School of Behavioural and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Eida Castro-Figuero
- Ponce Research Institute, School of Behavioural and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico.,Department of Psychiatry, School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Olga Garduño-Ortega
- Department of Psychiatry and Behavioural Sciences, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Rosario Costas-Muñiz
- Department of Psychiatry and Behavioural Sciences, Memorial Sloan Kettering Cancer Center, New York, United States.,Department of Psychiatry, Weill Cornell Medical College, New York, United States
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Jenkins N, Garduño-Ortega O, Smith M, Bushnik T. Assessing Educational and Resource Materials Needs for Patients and Caregivers Post-TBI. Arch Phys Med Rehabil 2019. [DOI: 10.1016/j.apmr.2019.08.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Costas-Muñiz R, Hunter-Hernández M, Garduño-Ortega O, Morales-Cruz J, Gany F. Ethnic differences in psychosocial service use among non-Latina white and Latina breast cancer survivors. J Psychosoc Oncol 2017; 35:424-437. [PMID: 28332946 DOI: 10.1080/07347332.2017.1310167] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study examined the use of psychosocial services (i.e., social work, psychiatric, psychological, and spiritual/pastoral services) among Latina and Non-Latina white breast cancer survivors. METHODS Survivors who received treatment in a Comprehensive Cancer Center in New York completed a mailed questionnaire about interest in help for distress, and psychosocial service use. Descriptive and non-parametric statistics were used to explore ethnic differences in use of, and interest in, psychosocial services. RESULTS Thirty-three percent of breast cancer survivors reported needing mental health or psychosocial services after their cancer diagnosis (33% Latinas, 34% whites); 34% of survivors discussed with their oncologist or cancer care provider their emotional problems or needs after the diagnosis (30% Latinas, 36% whites). Only 40% of the survivors who reported needing services received a referral for psychosocial services (42% Latinas, 39% whites). Sixty-six percent of survivors who reported needing services had contact with a counselor or mental health professional (psychiatrist, psychologist, or social worker) after their diagnosis (57% Latinas, 71% whites), and 61% of those needing services reported receiving psychosocial services (53% Latinas, 67% whites). Whites were significantly more likely than Latinas to have contact with a social worker (33% vs. 17%, respectively) and to receive psychotropic medication (15% vs. 0%, respectively). However, Latinas were significantly more likely to receive spiritual counseling than whites (11% vs. 3%, respectively). CONCLUSION Our study revealed gaps for both groups; however, the gaps differed by group. It is crucial to study and address potential differences in the psychosocial services availability, acceptability, and help-seeking behaviors of ethnically diverse cancer patients and survivors.
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Affiliation(s)
- Rosario Costas-Muñiz
- a Department of Psychiatry & Behavioral Sciences , Immigrant Health & Cancer Disparities Service, Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | | | - Olga Garduño-Ortega
- a Department of Psychiatry & Behavioral Sciences , Immigrant Health & Cancer Disparities Service, Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Jennifer Morales-Cruz
- c Center for Evaluation and Sociomedical Sciences , University of Puerto Rico, Medical Sciences Campus , San Juan , PR , USA
| | - Francesca Gany
- a Department of Psychiatry & Behavioral Sciences , Immigrant Health & Cancer Disparities Service, Memorial Sloan Kettering Cancer Center , New York , NY , USA
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