Disparities in prognosis communication among parents of children with cancer: The impact of race and ethnicity.

6562 Background: Most parents of children with cancer say they want detailed prognostic information about their child’s cancer. However, prior work has been conducted in populations of limited diversity. We sought to evaluate the impact of parental race/ethnicity on prognosis communication experiences amongst parents of children with cancer. Methods: We surveyed 357 parents of children with cancer, and the children’s physicians at Dana-Farber Cancer Institute/Boston Children’s Hospital and Children’s Hospital of Philadelphia. Our outcome measures were parental preferences for prognostic information, physician beliefs about parental preferences, prognosis communication processes and communication outcomes. Except where noted, associations were assessed by logistic regression with generalized estimating equations to correct for physician clustering. Results: 87% of parents wanted as much detail as possible about their child’s prognosis, with no significant differences by race/ethnicity (P = .50). Physician beliefs about parental preferences for prognosis communication varied based on parent race/ethnicity. 60% of physicians for White parents reported they believed parents wanted as much detail as possible about their child’s prognosis, versus 36%, 38%, and 64% of physicians, respectively, for Black, Hispanic, and Asian/Other parents (P = .04). Parent race/ethnicity was not associated with actual prognostic disclosure as reported by parents (P = .79) or by physicians (P = .61). Accurate understanding of prognosis was higher amongst White (51%) versus non-White parents (range 22%-29%), although this difference was not statistically significant (P = .13, unadjusted). Conclusions: The majority of parents, regardless of racial and ethnic background, want detailed prognostic information about their child’s cancer. However, physicians rarely recognize the information needs of Black and Hispanic parents. Despite this discrepancy, prognosis communication outcomes were largely equivalent. Our findings suggest that in order to meet parents’ information needs, physicians should ask about the information preferences of parents of children with cancer prior to prognosis discussions.

A single-spore analysis of rust pustules produced by mixing isolates of two races of Puccinia coronata var. avenue

Urediospores of pairs of isolates of Puccinia coronata var. avenae were simultaneously inoculated side by side on a susceptible oat leaf to produce a common pustule. The infection types of the culture from the single pustule, and from single-spore isolates of the pustule, were determined on key differential varieties distinguishing the component biotypes. The composition of the pustule was found to vary with the component races involved, and among pustules established from the same components.One pair of component races produced pustules which were phenotypically like one or the other of the isolates used in the mixture. Single-spore isolates from these pustules gave the same infection type as the pustule from which they were isolated, indicating that either one isolate alone produced the pustule, or that it predominated in what would then be a compound pustule.Another pair produced infection types unlike those of either parent race, and thus behaved phenotypically as a new race on the differential varieties. However, single-spore isolates from such pustules behaved as one or the other of the components. The masking effect of virulence over avirulence was also demonstrated by single-spore analysis of these compound pustules.

SELFING STUDIES WITH PHYSIOLOGIC RACES OF WHEAT STEM RUST, PUCCINIA GRAMINIS VAR TRITICI

Forty-two cultures of wheat stem rust (Puccinia graminis var. tritici Erikss. and Henn.), comprising 34 physiologic races, were subjected to selfing studies each of which involved the inoculation of barberry plants with the sporidia of a race, and the determination of the races in the uredial cultures derived from the aeciospores. In all of the cultures studied, the pathogenic properties expressed on the differential hosts appeared to be inherited according to the same principles. On the varieties Marquis and Kota (Triticum vulgare), pathogenicity of the races in the progeny tended to resemble that of the parent race. On Reliance (T. vulgare), avirulence was a dominant character, virulence a recessive one. On the durum wheats Arnautka, Mindum, and Spelmar, virulence was a dominant and avirulence a recessive character. On Einkorn (T. monococcum) and on Vernal (T. dicoccum), avirulence was dominant to virulence. In the progenies of some races, pathogenic variation occurred though it did not transgress the circumscribed limits of the parent race; the population therefore consisted chiefly of substrains (biotypes) of the same race.

INHERITANCE OF PATHOGENICITY AND UREDIOSPORE COLOR IN CROSSES BETWEEN PHYSIOLOGIC RACES OF OAT STEM RUST

In the F1 generation of crosses between physiologic races 7 (orange) and 11 (red) of Puccinia graminis Pers. var. Avenae Erikss. and Henn., the medium sized uredia (type 2 infection) formed by race 11 on the oat variety White Tartar were dominant to the large (type 4) uredia of race 7, and the small (type 1) uredia of race 7 on the variety Richland were dominant to the type 4 uredia formed by race 11. On the varieties Sevnothree and Joanette Strain, the F1 hybrids produced the same type of infection as did the "maternal" parent race, that is, hybrids from race 7 × race 11 crosses produced a type 4 infection like race 7, and reciprocal hybrids produced a type 1 infection like race 11. These facts led to the suggestion that the cytoplasm of the maternal parent race influenced the infection type of the F1 hybrid on these two oat varieties.A study of the F2 generation of the cross race 11 × race 7 showed that on the varieties White Tartar and Richland the dominant and recessive infection types appeared in a ratio of 9:7, which suggests that their inheritance is governed by two pairs of complementary genes. The distribution of physiologic races in F2 conforms to this assumption and indicates that the genes governing infection types on these two varieties associate at random to produce physiologic races 1, 11, 3, and 4. These races occurred in F2 in a ratio of 31: 20: 22: 12, as compared to an expected ratio of 27: 21: 21: 16. On the variety Sevnothree, 84 of 85 F2 cultures produced type 1 uredia, in this way resembling the maternal parent, race 1, and the maternal grandparent, race 11. One F2 culture, only produced the type 4 uredia characteristic of the paternal grandparent, race 7. It is concluded from this study, and from crosses between races 1 and 2, that the maternal (cytoplasmic) influence evidenced in the F1 generation persists m F2 and F3.In F1, the red urediospore color of race 11 was dominant to the orange color of race 7. The distribution in these two color classes in F2 and F3 suggests that the inheritance of urediospore color is governed by a single pair of genes.