Ethics, health disparities, and discourses in oncology nursing's research: If we know the problems, why are we asking the wrong questions?

Abstract

To disrupt conflations between 'health disparities research' and critical engagement with racism, whiteness, other oppressions and our profession's ongoing roles in white supremacy. In Oncology Nursing Society's (ONS) 2019-2023 research agenda, health disparities are highlighted as a top priority for nursing knowledge generation and intervention. The document concludes needs for increased 'minority and vulnerable population' participation in cancer clinical trials, reduced financial toxicity, behavioural interventions for risk reduction, incorporation of social determinants of health and technology to promote rural access to high-quality care. In this critical resistive, theoretical and ethical analysis on current discourses on health disparities research in oncology nursing, we ask: (a) What forces (stated and unstated) shape current oncology nursing discourses about health disparities?; (b) What assumptions about health and power are embedded in these discourses?; (c) Are we, as nurses and scientists, asking the right questions? Line-by-line analysis of the ONS Research Agenda for 2019-2023 'Health Disparities' section. The health disparities described in this report are not new to the literature, nor are many of the proposed solutions. As noted, disparities such as disproportionate cancer-related morbidity and mortality across identities (gender, race and sexual orientation) have not improved and some have worsened over several decades. That discourses on prioritising cancer-related health disparities persist while disparity-related outcomes remain largely unchanged presents challenges-both moral and pragmatic. We must ask, 'Rather than the concept of "health disparities," as presently understood in cancer nursing, what is the better approach to examine health equity and ethical nursing research practices?' This paper offers several starting places for nurses, especially with the following questions: 'Who does this harm?' Answer then revise: 'Who might this harm now?' Answer then revise: 'Are these harms worth the activity?' And repeat this process.