Research Proposal PART I Research Justification
Research Proposal PART I: Research Justification
Disparities in pediatric acute leukemia diagnosis, treatment, and access to healthcare are a critical health concern as they reduce quality outcomes and quality of life for the affected children and adolescents. Studies argue that disparities continue to affect better diagnosis, treatment, and access to healthcare services for pediatric patients suffering from blood cancers (Ding et al., 2022; Mishra et al., 2024; Swift et al., 2025), yet acute lymphoblastic leukemia is the most prevalent childhood cancer, constituting a significant global disease burden for the condition. Disparities across various socioeconomic and socio-demographic factors drive this research study with the aim of addressing prevalence through practical and evidence-based practice interventions.
Background
Disparities in different aspects of acute leukemia among children and adolescents affect treatment and survival rates based on quality care delivery. Mishra et al. (2024) advance that racial disparities are prevalent in pediatric patients suffering from acute leukemia. The study notes that white patients have an increased risk of getting acute lymphoblastic leukemia than black patients. Therefore, disparities exist in the prevalence or incidence, survival rates, diagnosis, and treatment of acute leukemia. Further, certain groups or racial and ethnic formations are likely to access better healthcare services due to socioeconomic determinants of health (SDOH) compared to others (Marcotte et al., 2022). Addressing these disparities is essential to improve patient outcomes, as it implies focusing on the social determinants of health and socio-demographic factors that influence the prevalence and access to treatment and diagnosis of the condition.
Additionally, acute leukemia is the most prevalent type of childhood cancer that continues to present challenges in disparities despite increasing efforts to understand and lower the contributing factors. Racial and ethnic disparities continue to occur at various points in the disease process, including risks, presentation, diagnosis, treatment, and survival rates (Aristizabal et al., 2021). For instance, black and Hispanic children have inferior outcomes compared to their white counterparts. Again, Hispanic children are both more likely to develop acute leukemia and have a higher risk for the disease compared to their non-Hispanic black and white counterparts.
Disparities in diagnosis and presentation also persist, as noted where black patients had increased prevalence of coagulopathy and a greater possibility of having 2 or more laboratory abnormalities compared to Latino and non-Hispanic white children (Winestone et al., 2023). Again, studies further demonstrate longer median or average times for diagnostic evaluations, including the evaluation of bone marrow and lumbar puncture among black and Hispanic patients compared to their white non-Hispanic counterparts (Xu et al., 2021; Gupta et al., 2022). Further, Hispanic patients present for diagnosis at an older age and are likely to present with central nervous system issues, leading to poor outcomes. These factors also demonstrate lower access to healthcare for Hispanic and black children. The implication is that healthcare providers must evaluate and determine the causes of these disparities and develop appropriate interventions to address them and improve outcomes for the affected population (Ding et al., 2025). Interventions focused on addressing the unmet needs of vulnerable families with pediatric cancer treatment, and developing approaches that deliver the highest quality, evidence-based practices to all patients with acute leukemia are critical.
Literature Review
A critical review and analysis of existing research studies demonstrates various aspects of the existence and types of disparities in diagnosis, treatment, and access to healthcare among pediatric patients with acute leukemia. Ding et al. (2022) argue that delays in diagnosis are a core reason for these disparities. They note that disease-associated factors contribute to diagnosis delays. The study recommends the implementation of evidence-based approaches to mitigate outcome disparities in pediatric patients with acute leukemia. Mishra et al. (2024) are categorical that racial disparities affect overall survival (OS) among pediatric patients with acute leukemia. Zhang et al. (2024) note that disparities in different aspects of acute leukemia are a global health issue and increase poor outcomes for patients, with limited resources in low and middle-income countries resulting in suboptimal outcomes. Advances in diagnostics and treatment lead to improved rates of survival. Therefore, efforts to prevent and treat pediatric acute lymphoblastic leukemia (ALL) need more attention to aspects like sufficient resource allocation and addressing health inequities that limit access to healthcare services. Xu et al. (2021) demonstrate the level of disparities in risk and survival rates for pediatric patients with acute lymphoblastic leukemia as emanating from various social determinants of health (SDOH) that the system should address to increase optimal outcomes in the affected population. Kahn et al. (2025) implore healthcare providers and health systems to improve health equity and increase the survival rates of pediatric patients diagnosed with blood cancers like acute leukemia. The study by Flowers et al. (2025) also underscores the importance of addressing health disparities through a shared responsibility approach that champions multidimensional strategies based on basic and translational science, community and family participation, and societal responsiveness for attaining meaningful effects on the selected population. Algiraigri (2025) notes that various factors are responsible for the persistent disparities, especially among racial minority children, who include immigrant children. Delays in diagnosis, advanced disease at presentation, and socioeconomic situations negatively affect and hinder timely and optimal care delivery.
Theoretical framework or conceptual model
Disparities in pediatric acute lymphoblastic leukemia occur across the care continuum, from diagnosis to treatment, and access to healthcare services. These disparities emanate from socioeconomic status (SES), lack of health insurance coverage, geographical location, parental education and health literacy levels, race or ethnicity, and aspects like systematic racism or discrimination, as well as health system ability, resources, and policies (Flynn, 2021). Imperatively, the study will employ the World Health Organization’s social determinants of health (SDOH) model as the theoretical framework, together with the Andersen Behavioral model (Thimm‐Kaiser et al., 2023). The integration of the two models enables the researcher to explain the macro-level determinants at the health system levels through social, economic, and policy structures using the SDOH model. Andersen’s behavioral model offers the micro-level or individual factors that determine healthcare services use and patient outcomes.
Research population
The selected research population entails pediatric patients who include children and adolescents diagnosed with acute leukemia, and encounter increased disparities due to various factors, as highlighted through socioeconomic and socio-demographic models. Acute lymphoblastic leukemia is a serious health condition and the most prevalent blood cancer among children and adolescents (Swift et al., 2024). While the survival rates are close to 90%, and despite several efforts to reduce disparities, they still exist (Gupta et al., 2022). Therefore, this population is critical to understanding the causes of disparities and developing appropriate approaches to address them.
Research Purpose and Aims
The main purpose of this study is to explore causes of disparities in diagnosis, treatment, and healthcare access among children and adolescents with acute leukemia. The research aims include:
- a) Identifying the causes of the disparities in diagnosis, treatment, and healthcare access
b). Expanding knowledge on interventions to address the causes of disparities
c). Developing evidence-based practice (EBP) interventions and policy measures to tackle the disparities
References
Algiraigri, A. H. (2025). Unequal Paths to Cure: Addressing Treatment Challenges and
Outcomes in Immigrant Children with Acute Lymphoblastic Leukemia. Journal of
Applied Hematology, 16(3), 247-251. DOI: 10.4103/joah.joah_74_25
Aristizabal, P., Winestone, L. E., Umaretiya, P., & Bona, K. (2021, June). Disparities in
pediatric oncology: the 21st century opportunity to improve outcomes for children and adolescents with cancer. American Society of Clinical Oncology Educational Book, 41: e315-e326. DOI: 10.1200/EDBK_320499.
Ding, F., Deng, L., Xiong, J., Cheng, Z., & Xu, J. (2025). Analysis of global trends in
acute lymphoblastic leukemia in children aged 0–5 years from 1990 to 2021. Frontiers in Pediatrics, 13, 1542649. https://doi.org/10.3389/fped.2025.1542649
Ding, L., Szymczak, J. E., Evans, E., Canepa, E., Martin, A. E., Contractor, F., … &
Winestone, L. E. (2022). Factors that contribute to disparities in time to acute leukemia diagnosis in young people: an in-depth qualitative interview study. BMC cancer, 22(1), 531. DOI: 10.1186/s12885-022-09547-8
Flowers, C. R., Anantha, R. W., Leautaud, V., Desai, P., Donald, C. E., Hildebrandt, M.
A., … & Melnick, A. M. (2025). Addressing Health Disparities in Hematologic
Malignancies: from Genes to Outreach. Blood cancer discovery, 6(2), 79-93.
https://doi.org/10.1158/2643-3230.BCD-24-0153
Flynn, M. B. (2021). Global capitalism as a societal determinant of health: A conceptual
framework. Social Science & Medicine, 268, 113530.
DOI: 10.1016/j.socscimed.2020.113530
Gupta, S., Teachey, D. T., Chen, Z., Rabin, K. R., Dunsmore, K. P., Larsen, E. C., … &
Devidas, M. (2022). Sex‐based disparities in outcome in pediatric acute lymphoblastic leukemia: a Children’s Oncology Group report. Cancer, 128(9): 1863-1870. https://doi.org/10.1002/cncr.34150
Kahn, J., Bojilova-Dor, L., Ray, M., & McHenry, K. (2025). Improving Health Equity for
Children and Adolescents With Blood Cancers. The Hematologist, 22(6).
https://doi.org/10.1182/hem.V22.6.2025612
Marcotte, E. L., Domingues, A. M., Sample, J. M., Richardson, M. R., & Spector, L. G.
(2021). Racial and ethnic disparities in pediatric cancer incidence among children
and young adults in the United States by single year of age. Cancer, 127(19),
3651-3663. https://doi.org/10.1002/cncr.33678
Mishra, A., Mathews, M., Belleville, T., Silberstein, P., & Swedek, M. (2024). Racial disparities in pediatric patients with acute lymphoblastic leukemia: A National
Cancer Database analysis. Pediatric Hematology Oncology Journal, 9(1), 40-41.
https://doi.org/10.1016/j.phoj.2024.02.001
Swift, C. M., Chism, E., Lin, K., Cortella, A., Banerjee, T., Alvarez, J. S., & Winestone, L.
- (2025). Lower Neighborhood Socioeconomic Status Is Associated With
Intensive Care Unit Admission at Initial Presentation in Children With Acute
Leukemia. Pediatric Blood & Cancer, e32049. https://doi.org/10.1002/pbc.32049
Rimawi, R. A., Carpenter, K., Taleb, W., Lehmann, L., Saleh, H., & Madani, N. (2025).
Disparities in pediatric oncology access and outcomes in the occupied
Palestinian territories: a retrospective study from Augusta Victoria Hospital.
EClinicalMedicine, 88.
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00395-5/fulltext
Thimm‐Kaiser, M., Benzekri, A., & Guilamo‐Ramos, V. (2023). Conceptualizing the
mechanisms of social determinants of health: a heuristic framework to inform
future directions for mitigation. The Milbank Quarterly, 101(2), 486-526.
Winestone, L. E., Getz, K. D., Li, Y., Burrows, E., Scheurer, M. E., Tam, V., … & Aplenc,
- (2024). Racial and ethnic disparities in acuity of presentation among children
with newly diagnosed acute leukemia. Pediatric blood & cancer, 71(1), e30726.
https://doi.org/10.1002/pbc.30726
Xu, K., Feng, Q., Wiemels, J. L., & de Smith, A. J. (2021). Disparities in acute
lymphoblastic leukemia risk and survival across the lifespan in the United States
of America. Journal of Translational Genetics and Genomics, 5(3), 218-239. http://dx.doi.org/10.20517/jtgg.2021.20
Yang, X., Mosha, M., Bell, D., Dean, J., Mayer, J., & Amankwah, E. K. (2025). Age and
Sex Differences in the Prevalence of Specific Comorbidities among Patients with
Pediatric Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma at
Diagnosis. Cancer Research Communications, 5(4), 549-555.
https://doi.org/10.1158/2767-9764.CRC-24-0517
Zhang, N., Wen, D., Wang, T., & Deng, J. (2024). Disparities in incidence and mortality
of pediatric acute lymphoblastic leukemia across countries with different
incomes. Leukemia, 38(12), 2731-2734.
https://doi.org/10.1038/s41375-024-02433-1
CLICK HERE TO ORDER A PLAGIARISM-FREE PAPER
Part I Research Justification: Addressing Disparities in Pediatric Acute Leukemia Diagnosis, Treatment, and Healthcare Access.
Background, Literature Review and Research Aims. Page limit no longer than 4 pages (about 1000 words).
Describing your project in this section: Your goal is to provide a compelling argument about the importance of your research and the need to conduct your research. What do we already know, and
what do we still need to uncover? Is your research topic important? If yes, how so and include epidemiological data to support the significance of this issue. Also included the following:
1. Introduction to your topic. Make sure to support this with literature.
2. Provide the background about your topic. Please make sure to include relevant citations on the project background, indicating why this research is important and why the study should be done. This section must convey a compelling rationale for your study. It should indicate what we know (research previously completed on the topic) and any gaps in the literature that your research will attempt to answer.
3. Discuss the theoretical framework or conceptual model guiding your project. A graphical display (table or figure) is ideal, but not required. If you are using a theory, tell us about the theory or model, how has it been applied as it relates to your topic or population, and why it is relevant for the proposed project.
4. Tell us about the population you seek to conduct research with. Why is it relevant to include this population?
5. Include your research purpose (goal) and your specific aims.
6. Citations should be recent (within the last 10 years). Seminal studies (groundbreaking research that paved the way in the scientific field) is an exception to the time period requirement. Include approximately 15-20 sources. Multi-citation is expected.
7. Synthesis of cited work is expected. Do not provide a summary of each study previously conducted. This is not research synthesis. Make sure it tells a complelling story to justify why your research proposal is important.