Improving Outcomes for Latinos on Hemodialysis with Limited English Proficiency

改善英语水平有限的拉丁裔血液透析的结果

• 批准号: 10667752
• 负责人: Lilia Cervantes
• 金额: $ 18.55万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10667752
• 关键词: Address; Adherence; Adult; Advisory Committees; Affect; Appointment; Award; Caring; Clinical; Clinical Trials Design; Cognitive Therapy; Colorado; Communication Barriers; Communities; Data; Data Collection; Depressed mood; Development; Dialysis procedure; Dissemination and Implementation; Education; Effectiveness of Interventions; End stage renal failure; Foundations; Funding; Future; Generations; Goals; Health; Hemodialysis; Immigration; Individual; Intervention; Interview; Kidney; Language; Latina; Latino; Latino Population; Limited English Proficiency; Measures; Mediation; Medical center; Mental Depression; Mental Health Services; Mentors; Modeling; Morbidity - disease rate; Nephrology; Outcome; Pathway interactions; Patients; Physicians; Population; Poverty; Randomized; Randomized Controlled Trials; Reporting; Research; Research Personnel; Research Training; Schedule; Site; Social Workers; Structure; Time; Training; Treatment Efficacy; Universities; Visit; Vulnerable Populations; Wood material; Work; acceptability and feasibility; bilingualism; care seeking; career; depressive symptoms; effectiveness evaluation; experience; feasibility testing; health related quality of life; high risk population; implementation intervention; improved; improved outcome; innovation; instrument; mortality; motivational enhancement therapy; navigator intervention; patient oriented; peer; preference; primary outcome; recruit; secondary outcome; social; social factors; standard care; supportive environment; therapy adherence; treatment as usual

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.

项目概要/摘要 患有终末期肾病 (ESRD) 的拉丁美洲人占美国成人 ESRD 群体的 17% 与非拉丁裔白人相比，他们出现抑郁情绪的可能性是非拉丁裔白人的 1.6 倍。抑郁影响 ESRD 患者的健康相关生活质量 (HRQOL) 下降、肾功能下降 治疗依从性、发病率和死亡率增加。此外，抑郁情绪也会产生不利影响 受到有限英语水平（LEP）和许多其他社会因素的影响。在阿莫斯的支持下 获得罗伯特·伍德·约翰逊基金会 (RWJF) 颁发的奖项后，莉莉娅·塞万提斯博士评估了 5- 访问非专业同行导航干预，以支持面临社会挑战的拉丁裔 ESRD 患者并激活 他们寻求心理保健。她的同伴导航干预是可行的；然而，她的研究表明 三分之二的英语水平有限的拉丁裔 ESRD 患者报告有抑郁情绪，但不寻求治疗 由于文化偏好和语言障碍而导致的护理。拟议的研究将建立在她的 Amos RWJF 基础上 通过扩大同伴导航干预来开展工作，将双语持照临床社会工作者纳入其中 (LCSW) 将提供个体透析主席旁认知行为治疗 (CCBT) 课程，同时 同伴导航器提供社会因素的支持。这种以患者为中心的方法是根据文化量身定制的， 将缩小心理健康服务的差距。该提案的总体目标是： 1) 吸引关键 运营和临床利益相关者尽早培养同行导航员许可的临床社会工作者 (PN-LCSW) 干预； 2) 对 PN-LCSW 干预与标准护理进行试点随机对照试验进行测试 可行性和可接受性； 3）评估干预措施对抑郁情绪的有效性（主要 结局）以及与健康相关的生活质量和血液透析依从性（次要结局）。这 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 成为一名独立的医师调查员和领导者，为拉丁裔开发适合文化的护理模式 英语水平有限的 ESRD 患者可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) 以患者为中心的临床结果分析，包括纵向数据和中介 分析。塞万提斯博士将在丰富和支持性的环境中完成她的研究和培训目标 在她出色的支持下，在科罗拉多大学安舒茨医学中心和丹佛健康中心工作 主要导师 Michel Chonchol 博士（肾脏病学）。塞万提斯博士将为 改善 ESRD 和英语能力有限的弱势群体中以患者为中心的临床结果 熟练程度，同时获得开始独立职业生涯所需的经验和培训 医师调查员。

项目成果

Experiences of Latinx Individuals Hospitalized for COVID-19: A Qualitative Study.

• DOI: 10.1001/jamanetworkopen.2021.0684
• 发表时间: 2021-03-01
• 期刊: JAMA network open
• 影响因子: 13.8
• 作者: Cervantes L;Martin M;Frank MG;Farfan JF;Kearns M;Rubio LA;Tong A;Matus Gonzalez A;Camacho C;Collings A;Mundo W;Powe NR;Fernandez A
• 通讯作者: Fernandez A

Toward Equitable COVID-19 Vaccine Distribution-Building Trust and Investing in Social Services.

• DOI: 10.1001/jamanetworkopen.2021.27632
• 发表时间: 2021-09-01
• 期刊: JAMA NETWORK OPEN
• 影响因子: 13.8
• 作者: Cervantes, Lilia

Barriers to providing optimal dialysis care for undocumented immigrants: Policy challenges and solutions.

为无证移民提供最佳透析护理的障碍：政策挑战和解决方案。

• DOI: 10.1111/sdi.12846
• 发表时间: 2020
• 期刊: Seminars in dialysis
• 影响因子: 1.6
• 作者: Welles,ChristineC;Cervantes,Lilia
• 通讯作者: Cervantes,Lilia

Qualitative analysis of stakeholder perspectives on engaging Latinx patients in kidney-related research.

• DOI: 10.1186/s12882-023-03128-y
• 发表时间: 2023-03-30
• 期刊: BMC NEPHROLOGY
• 影响因子: 2.3
• 作者: Alvarado, Flor;Delgado, Cynthia;Nicholas, Susanne B.;Jaure, Allison;Cervantes, Lilia
• 通讯作者: Cervantes, Lilia

Differences in Outcomes by Place of Origin among Hispanic Patients with Kidney Failure.

西班牙裔肾衰竭患者因出生地不同而导致的结果存在差异。

• DOI: 10.1681/asn.0000000000000239
• 发表时间: 2023
• 期刊: Journal of the American Society of Nephrology : JASN
• 作者: Rizzolo,Katherine;Cervantes,Lilia;Wilhalme,Holly;Vasilyev,Arseniy;Shen,JennyI
• 通讯作者: Shen,JennyI