Older Sexual and Gender Minority Patients with Serious Illness: Program-Building to Identify and Address Needs

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This NIA K07 Academic Leadership Career Award resubmission entitled, “Older Sexual and Gender Minority Patients with Serious Illness: Program-Building to Identity and Address Needs,” seeks to help these understudied and underserved groups of patients, who, in the face of advanced age and serious illness, are more likely to be single, living alone, without children, lacking in social support, and at risk for and fearful of discrimination. The applicant is a senior physician at Mayo Clinic and has a long track record of research in studying symptoms and psychosocial issues in ill patients (400+ publications), mentoring (50+ mentees + principal investigator/program director of career development program K12CA090628-20), and serving as a leader in both her home institution and nationally. This track record and these experiences are brought to this application with the goal of understanding and addressing the unmet needs of these groups of older sexual and gender minority (SGM) patients – defined by the NIH as “individuals who identify as lesbian, gay, bisexual, transgender, two-spirit, queer, and/or intersex.” A uniquely rich institutional environment that includes the Kogod Center on Aging; the Mayo Clinic Cancer Center (an NCI-designated comprehensive cancer center); a robust Center for Clinical and Translational Science (CCATS); a nationally renowned statistics and data center; the robust Mayo Clinic practice, which provides depth and breadth of clinical expertise in the management of a vast array of serious illnesses to over 1 million patients per year; and, last but not least, the 120,000+ (and growing) social media platform, Mayo Clinic Connect -- perhaps the largest such patient-centric electronic medical resource in the world -- will set the stage for the development of this programmatic infrastructure. Novel, ground-breaking research early in the grant-cycle will consist of a needs-assessment that uses both qualitative and quantitative methodology to learn the unremitting symptomatology and unrelieved psychosocial hardships of these older patients and that relies on Mayo Clinic Connect (an estimated 30% of users self-report as 65+ years of age) to reach older SGM patients anonymously and to learn confidentially about their concerns. This needs assessment will give rise to a series of annual requests for pilot grant applications aimed at young investigators. Young investigators who are awarded a pilot project will acquire mentoring from the applicant, engage in coursework, participate in a weekly seminar series, learn from a biannual visiting professor series, begin to learn to contribute to CCATS course development on older SGM patients, and further launch their careers as investigators in this field. National/international experts in their respective fields and a patient advocate will serve on an advisory committee, providing programmatic guidance over the 5-year grant cycle. These efforts are destined to establish a sustainable, funded research program to improve the lives of older SGM patients with serious illness.