Improving Outcomes for Latinos on Hemodialysis with Limited English Proficiency

项目概要/摘要 拉丁裔终末期肾病（ESRD）患者占美国成人ESRD社区的17%， 与非拉丁裔白人相比，他们患抑郁症的可能性高出1.6倍。抑郁情绪 在ESRD患者中，与健康相关生活质量（HRQOL）降低、肾功能下降相关。 治疗依从性、更高的发病率和更高的死亡率。此外，抑郁情绪对 受英语水平有限（LEP）和许多其他社会因素的影响。在阿莫斯人的支持下 来自罗伯特·伍德约翰逊基金会（RWJF）的奖项，Lilia塞万提斯博士评估了5- 访问外行同行导航干预，以支持有社会挑战的拉丁裔ESRD患者，并激活 寻求心理健康。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， 由于文化偏好和语言障碍而受到照顾。拟议的研究将建立在她的阿莫斯RWJF 通过扩大同伴导航干预，包括双语持牌临床社会工作者 （LCSW）将提供个人透析椅旁认知行为治疗（CCBT）课程， 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文化定制的， 将弥合精神健康服务的差距。本提案的总体目标是：（1）使关键 运营和临床利益相关者早期开发同行导航许可临床社会工作者 （PN-LCSW）干预; 2）进行PN-LCSW干预与标准治疗的试点RCT，以测试 可行性和可接受性; 3）评估抑郁情绪干预的有效性（主要 结果）以及健康相关的生活质量和血液透析依从性（次要结果）。的 Lilia塞万提斯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，为拉丁美洲人制定文化定制的护理模式 英语水平有限的ESRD患者，以改善以患者为中心的临床结局。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）关键利益相关者参与; 2）临床 试验设计;以及3）以患者为中心的临床结局分析，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， 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人群中以患者为中心的临床结局 熟练，同时获得必要的经验和培训，开始她的职业生涯作为一个独立的 医生调查员。

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.