Improving Outcomes for Latinos on Hemodialysis with Limited English Proficiency

项目摘要/摘要 患有终末期肾病(ESRD)的拉丁裔人占美国成年ESRD社区的17%， 与非拉丁裔白人相比，他们患抑郁情绪的可能性高出1.6倍。抑郁情绪 终末期肾病患者与健康相关生活质量(HRQOL)降低、肾脏减少相关 坚持治疗、更高的发病率和更高的死亡率。此外，抑郁情绪也是不利的。 受英语水平有限(LEP)和许多其他社会因素的影响。在阿莫斯的支持下 罗伯特·伍德·约翰逊基金会(RWJF)授予的奖项，莉莉亚·塞万提斯博士评估了5- 访问Lay Peer Navigator干预，以支持有社交挑战的拉丁裔ESRD患者并激活 他们寻求精神保健。她的同伴导航员干预是可行的；然而，她的研究表明 在英语水平有限的拉丁裔ESRD患者中，三分之二的人报告有抑郁情绪，但不寻求 由于文化偏好和语言障碍的关爱。拟议的研究将以她的Amos RWJF为基础 通过扩大同伴导航员干预，将双语执业临床社会工作者包括在内 (LCSW)将提供个人透析主席的认知行为治疗(CCBT)会议，而 同伴导航员提供了社会因素的支持。这种以患者为中心的方法是根据文化量身定做的 将缩小与心理健康服务之间的差距。这项提议的总体目标是：1)参与关键 运营和临床利益相关者及早开发具有Peer Navigator执照的临床社会工作者 (PN-LCSW)干预；2)进行PN-LCSW干预与标准护理对照的试验性随机对照试验 可行性和可接受性；以及3)评估干预对抑郁情绪的效果(初级 结果)以及与健康相关的生活质量和血液透析依从性(次要结果)。这个 这个K23的候选人Lilia Cervantes博士是第一代双语拉丁裔，她的长期目标是 成为一名独立的医生、调查员和领导者，为拉丁裔开发文化定制的护理模式 ESRD患者的英语水平有限，以改善以患者为中心的临床结果。这个K23 将为塞万提斯博士提供培训，以发展以下方面的专业知识：1)关键利益相关者的参与；2)临床 试验设计；3)以患者为中心和临床结果的分析，包括纵向数据和中介 分析。塞万提斯博士将在丰富和支持的环境中完成她的研究和培训目标 在科罗拉多大学安舒茨医学中心和丹佛健康中心，在她出色的支持下 首席导师Michel Chonchol博士(肾脏病)。塞万提斯博士将为 改善患有ESRD和英语受限的易感人群的以患者为中心和临床结果 精通，同时获得开始独立职业生涯所需的经验和培训 内科调查员。

PROJECT SUMMARY/ABSTRACT Latinos with End-Stage Renal Disease (ESRD) represent 17% of the US adult ESRD community and compared to non-Latino whites, they are 1.6 times more likely to develop depressive affect. Depressive affect among ESRD patients is associated with a reduced Health-Related Quality of Life (HRQOL), reduced renal therapy adherence, greater morbidity, and increased mortality. In addition, depressive affect is adversely affected by Limited English Proficiency (LEP) and many other social factors. With support from the Amos award from the Robert Wood Johnson Foundation (RWJF), Dr. Lilia Cervantes assessed the feasibility of a 5- visit lay Peer Navigator intervention to support Latino ESRD patients with social challenges and to activate them to seek mental healthcare. Her peer navigator intervention is feasible; however, her research showed that two-thirds of Latino ESRD patients with limited English proficiency report depressive affect yet do not seek care due to cultural preferences and language barriers. The proposed study will build on her Amos RWJF work by expanding the peer navigator intervention to include a bilingual Licensed Clinical Social Worker (LCSW) that will provide individual dialysis Chairside Cognitive Behavioral Therapy (CCBT) sessions while the peer navigator provides support with social factors. This patient-centered approach is culturally tailored and will bridge the gap to mental health services. The overall aims of this proposal are to: 1) engage key operational and clinical stakeholders early-on to develop a Peer Navigator-Licensed Clinical Social Worker (PN-LCSW) intervention; 2) conduct a pilot RCT of the PN-LCSW intervention versus standard care to test feasibility and acceptability; and 3) assess the efficacy of the intervention on depressive affect (primary outcome) as well as health-related quality of life and hemodialysis adherence (secondary outcomes). The candidate for this K23, Dr. Lilia Cervantes, is a 1st generation bilingual Latina and her long-term objective is to be an independent physician investigator and leader developing culturally tailored models of care for Latino ESRD patients with limited English proficiency to improve patient-centered and clinical outcomes. This K23 will provide Dr. Cervantes with the training to develop expertise in: 1) key stakeholder engagement; 2) clinical trial design; and 3) analysis of patient-centered and clinical outcomes including longitudinal data and mediation analysis. Dr. Cervantes will accomplish her research and training aims in the rich and supportive environment at the University of Colorado Anschutz Medical Center and Denver Health with the support from her excellent primary mentor Dr. Michel Chonchol (nephrology). Dr. Cervantes will make a significant contribution toward improving patient-centered and clinical outcomes among vulnerable populations with ESRD and limited English proficiency while obtaining the experience and training necessary to begin her career as an independent physician investigator.