Research

Sociology of Health and Illness, Urban Sociology, and Health Inequalities

Hablando de Muerte: Health Inequalities in Access to Cancer Care among Latino Patients

This research explores the processes by which terminal Latino cancer patients and their family members access medical
facilities, navigate healthcare institutions, attempt to treat cancer, and plan for death. I use a qualitative multi-method
research design, to document how participants access cancer care, observe how participants navigate healthcare
bureaucracies, examine how participants talk about death (or ignore the subject) with loved ones, and analyze the ways
patients and family members come to some sort of consensus about future goals considering the dire medical circumstances.
A multi-method qualitative research design generates various types of data, which allows for fine-grain analyses, which in turn
helps trace the different mechanisms through which health inequalities are reproduced and the ways patients respond to
experiencing such inequalities. This project contributes to existing knowledge by uncovering the ways health inequalities shape
terminal cancer care for Latino patients. By studying how racial/ethnic inequalities influence healthcare access and the resources (both material and social) that patients use to navigate healthcare institutions, findings from this study can provide new insights for future researchers that want to study the relationship between race/ethnicity and health inequalities and the influence that socioeconomic factors have of healthcare access. This project is supported by the National Science Foundation (NSF), through an SBE Postdoctoral Research Fellowship.

The Postpartum Access to Healthcare (PATH) Project

This project describes the healthcare system from the perspectives of uninsured and underserved pregnant and postpartum
women. Working with a team of researchers, we are interviewing 30 women who are eligible for Medicaid for Pregnant Women or CHIP Perinate in Central Texas at three-time points: 1) at the late prenatal stage of pregnancy (32-40 weeks), 2) at 1-2 months postpartum, and again at 3) 4-6 months postpartum. Data is also collected through participant journaling and focus groups. This project looks to document participants’ well-being, perceptions of healthcare needs, perceived resources and options related to care, and experiences when seeking care. We also interview key informants, clinicians, and health clinic staff, to document and describe the availability of care as well as staff understanding, experience with, and perspective on relevant state programs. The PATH project will provide information on how state programs such as Healthy Texas Women are being implemented and experienced by the population they aim to serve, and identify factors influencing program effectiveness and utilization. We plan on assessing how state programs can best be integrated with local programs to maximize resources and improve women’s access, experiences, and health. Recommendations will include shorter-term strategies, such as approaches to increase knowledge and effective sharing of resources; and longer-term strategies that may involve organizational, systems and policy changes. This project will result in plain-language materials targeting a variety of audiences, including providers, policymakers and state-level administrators, as well as academic publications. The PATH project is funded with support from the St. David’s Foundation and is sponsored by The University of Texas System, Population Health, and the Texas Collaborative for Healthy Mothers and Babies (TCHMB).

Medical Sociology and Social Psychology

The Social Order of Oncology Clinics: Examining End-of-Life Discussions, Decisions, and Care

My dissertation project explores the interactional and organizational forces that shape the medical care of
terminally-ill patients. Using the case of a cancer clinic in a large university hospital, I explore how terminally-ill
patients, their family members, and oncologists discuss the topic of death, make treatment decisions, and plan for
the end of life. I also trace the influence that the work oncologists, nurses, palliative care specialists, and clinical trial
representatives conduct prior to clinical visits have on the care terminally-ill patients receive. This multi-method
qualitative project relies heavily on ethnographic observations, conversation analysis, and in-depth semi-structured
interviews. My fieldwork and analysis were supported by institutions like the National Center for Complementary
and Integrative Health (NCCIH) at the National Institutes of Health (NIH), the Holtz Center for Science and Technology
Studies, and the National Science Foundation (NSF). For copies of working papers or articles that under review from
this project please email me (dcortez2@wisc.edu).

Oncology and Conversation Analysis

 

I collaborated on Douglas Maynard and Toby Campbell’s study to do secondary data analysis on 128 audio-recorded
conversations between advanced lung cancer patients and their oncologists. We used conversation analysis (CA) to map
the intricate ways clinicians and patients avoided explicitly discussing end-of-life issues and death. This work resulted in
three publications that used an interaction order and CA approach. The first publication, “’End of Life’ Conversations,
Appreciation Sequences, and the Interaction Order in Cancer Clinics”, published in Patient Education and Counseling,
analyzed how oncologists used patients’ illness understanding to assert a positive assessment of their prognosis and
treatment options. The second article, “Characterizing the Nature of Scan Results Discussions: Insights into Why
Patients Misunderstand their Prognosis,” published in the Journal of Oncology Practice, characterized how oncologists
discussed prognostic information with patients with advanced cancer and identified how these discussions contributed
to patients’ misperceptions of their illness. The article also showed how oncologists spend little time discussing scan results
and the negative prognostic implications of favoring treatment-related talk. The third paper, “Creating Space to Discuss
End-of-Life Issues in Cancer Care”, is published in the special issue End of Life, in Patient Education and Counseling.
This paper argues that when oncologists break the bad news that a patient’s treatment is no longer effective, they often use
a conversational device we call an “exhausted current treatment” (ECT) statement, which avoids discussing prognosis in
favor of further treatment options. The project was supported by the National Cancer Institute grant #P50 CA095817.

 

Community and Urban Sociology, Space, and Inequality

Cultivating Collective Action: Contesting Urban Growth Logic Using Deliberative Democratic Tactics 

In this project, I examined how a racially and economically diverse community used deliberative democratic tactics to build
a coalition and contest the sale of public land to urban land developers. Using ethnographic observations, in-depth interviews,
and archival research, I explored the varied forms of collective action used by a community to challenge the state for control of
public land. I argue that deliberative democratic decision-making, which participants called “the process,” within a grassroots
community movement, created a mechanism through which grievances and disagreements could be aired and resolved. While
this form of decision-making was time-consuming, it also helped generate and maintain a collective identity. In particular,
“the process” provided the space and opportunity for community members to hone and refine their interpretive and
diagnostic frames. My analysis shows how a small group of people was able to contest the state for control of public land by:
1) using two tactics that are often theorized as incongruous—i.e., conflict and consensus mobilization; 2) draw on an array of
direct action techniques; and, 3) team with partners outside the community to put pressure on city and state officials and raise
money to purchase the land from the state. For a copy of this paper please email me (dcortez2@wisc.edu).

Poverty and Food Insecurity in Wisconsin

I collaborated on Katherine Curtis’ project that mapped inequality throughout the state of Wisconsin by focusing on poverty and
food insecurity at the county-level. This research resulted in various reports and county-level graphs. This project found that due
to worsening economic conditions in Wisconsin (e.g., rising unemployment and two significant recessions) a growing share
of households faced food insecurity and were living in poverty. The groups that were at higher-than-average risk of poverty in
Wisconsin included single-mother households, children, racial/ethnic minorities, and adults with a high school education or less.