Feasibility of Medically Tailored Meals for Pediatric Populations at Risk for Disparities in Serious Illness Outcomes due to Inequities in Food-Related Social Drivers of Health - Project Summary/Abstract Food and nutrition insecurity are clinically relevant, actionable social drivers of health (SDOH) disparities in pediatric populations experiencing serious illnesses, for example, cancer. One approach being studied to address outcome disparities driven by food-related SDOH in the pediatric cancer context is to provide gift cards for an online grocery delivery platform. Prior research on compensatory cost coping with illness-related financial burden suggests that parents may stretch these food dollars by purchasing lower priced food with poor nutritional value. We also know that parents and siblings may cope with illness-related financial burden by going without food and other basics to conserve household assets to meet the needs of the child who is ill, which heightens parent and siblings’ risk for health disparities. To address health disparities in food insecure households coping with serious pediatric illness, we need holistic models of care that integrate food and nutrition with state of the science clinical care. Medically tailored meals (MTM; home-delivered meals tailored to medical needs of individuals with SDOH + barriers to preparing healthy food) that consider nutrition, illness- related alterations in taste, and parental time demands offer a Food is Medicine approach to addressing food insecurity-related outcome disparities in pediatric serious illness populations. In studies of adults with health conditions, MTM interventions were associated with better health outcomes and less health care spending. We extend the MTM concept to pediatric populations in which inequities in SDOH can affect serious illness outcomes, using pediatric cancer as proof of concept (POC). Our purpose is to determine feasibility of our methods and MTM intervention for a future efficacy trial to improve food and nutrition security for households of children at risk for poorer cancer outcomes due to inequities in food-related SDOH. We will accomplish our aims by collaborating with a small business that makes tasty, healthy frozen meals with start-up funding from National Institute of Minority Health and Health Disparities. Our primary research question: is an intervention that provides healthy, frozen meals tailored to tastes of children undergoing chemotherapy feasible and acceptable to the children and their primary parental caregiver? During year 1, we will conduct taste tastings with children treated with chemotherapy to inform adaptation of meal flavorings to treatment-related taste alterations (Aim 1). In year 2, we will collect quantitative and qualitative data at multiple time points from children undergoing chemotherapy and their parents to inform rapid, data-driven refinements in our methods and intervention. Our results will inform the potential and protocol for a future full-scale trial and cost effectiveness studies that inform policies extending healthcare financing models to include MTM in pediatric outpatient settings where children with serious illness receive care. The project aligns well with the socio- ecological perspective of National Institutes of Nursing Research’s 2022 strategic plan, and its health equity, SDOH and models of care research lenses.
