Improving Care at the End of Life for Latinos:A Cultural Navigator Intervention

候选人：候选人Stacy M.Fischer，医学博士，致力于成为跨文化临终关怀领域的一名独立资助的研究人员。她的背景包括以前在未得到充分服务的人群中的工作，临终关怀的临床和研究方面的经验，特别是老年患者，以及内科和老年学方面的培训。目前，Fischer博士得到了国家Brookdale奖学金计划和NCI/NIA P20试点拨款的支持，并完成了对临终关怀文化偏好的定性和定量研究。NIA/Beeson K23职业发展奖将为她提供受保护的时间和资源，以研究实施旨在改善拉美裔老年护理的文化导航员干预措施的有效性。环境：菲舍尔博士可以得到的指导和机构资源是非常出色的。赞助商Jean Kutner医学博士、MSPH医学博士、Andrew Kramer医学博士和Angela Sauaia医学博士， 共同发起人将传授各自在临终关怀、老年医学、卫生服务方面的专业知识 研究、患者导航干预、行为科学和跨文化研究。 研究计划：拟议研究的总体目标是改善对重病老年人的临终关怀。拉美人通过文化导航者或Guia，提供文化定制的干预。该项目的第一步是，通过社区成员和该领域专家参与的多步骤程序，编写干预和培训Guia所需的材料。该项目的下一阶段是文化导航者干预的先锋随机对照试验，目标是患有晚期癌症的拉丁裔人。 该干预措施旨在通过确定撤药率、评估提前护理计划、改善疼痛管理和临终关怀利用的比率来评估实施干预措施的完全有效的随机对照试验的可行性。拟议的研究还包括开发一种方法，以评估干预与常规护理的成本效益。

DESCRIPTION (provided by applicant): Candidate: The candidate, Stacy M. Fischer, MD, is committed to becoming an independently-funded researcher in the area of cross-cultural end-of-life care. Her background includes previous work with underserved populations, experience in the clinical and research aspects of end-of-life care, with a specific focus on elderly patients, and training in Internal Medicine and Geriatrics. Currently, Dr. Fischer is supported by the National Brookdale Fellowship Program and an NCI/NIA P20 pilot grant and completing a qualitative and quantitative study of cultural preferences for end-of-life care. The NIA/Beeson K23 Career Development Award will provide her the protected time and the resources to study the efficacy of implementing a cultural navigator intervention designed to improve end-of-life care for elderly Latinos. Environment: The mentorship and institutional resources available to Dr. Fischer are exceptional. Jean Kutner, MD, MSPH, the sponsor, and Andrew Kramer, MD, Al Marcus, PhD, and Angela Sauaia, MD, PhD, the co-sponsors, will impart their respective expertise in end-of-life care, geriatrics, health services research, patient-navigation interventions, behavioral science, and cross-cultural research. Research Plan: The overall goal of the proposed study is to improve end-of-life care for seriously ill older. Latinos through a cultural navigator, or guia, delivering a culturally tailored intervention. The first step of the project is to develop, through a multi-step process involving community members and experts in the field, the materials needed for the intervention and to train the guia. The next phase of the project is a vanguard randomized controlled trial of the cultural navigator intervention, targeting Latinos with advanced cancer. The intervention is designed to assess the feasibility of conducting a fully powered randomized controlled trial of the intervention by determining withdraw rates, and estimating rates of Advance Care Planning, improved pain management, and utilization of hospice care. The proposed study also includes development of a method to assess the cost-effectiveness of the intervention versus usual care.