Apoyo Con Carino: Patient Navigation for Palliative Care
Condition: Cancer
Study type: Interventional

Summary: 
      Palliative care is a priority area of focus for health care in an aging population
      experiencing burdens of chronic illness. Despite the evidence-based benefits of palliative
      care, access remains limited, especially in poor urban and rural settings. Cultural and
      linguistic barriers may also increase disparities in palliative care for Latinos. Due to a
      nationwide shortage of palliative care providers and the unique cultural preferences and
      values of patients, the investigators are testing a patient navigator intervention to improve
      palliative care outcomes for Latinos with advanced cancer.
    

Detailed description: 
      This project uses a patient navigator to deliver a culturally tailored intervention to
      improve palliative care for Latinos with advanced cancer in urban and rural communities. The
      proposed research aims to improve palliative care with the goal of preventing and relieving
      suffering for people facing serious, complex illness. Palliative care, according to the
      National Quality Forum and Centers for Medicare and Medicaid, provides patient and
      family-centered care offered in conjunction with curative and all other appropriate forms of
      medical treatment. It addresses physical, intellectual, emotional, social, spiritual needs,
      and facilitates patients' understanding of illness and choice. There is emerging evidence
      that palliative care may also improve survival for cancer patients. The proposed research
      also focuses on reducing health disparities. Studies have shown that Latinos are more likely
      to die in a hospital, less likely to use hospice services, and more likely to have unmanaged
      pain. This study will recruit 240 Latino patients with advanced cancer from an urban safety
      net hospital, a National Cancer Institute-designated Comprehensive Cancer Center, and several
      rural communities (including some of the poorest, most underserved counties in Colorado).
      Patients will be randomized to either a control or intervention group. The control group will
      receive written materials covering three important palliative care domains -advance care
      planning, pain management, and hospice care. The materials, in English and Spanish, are
      appropriate for patients with low health literacy. Patients in the intervention group will
      receive the same written materials but will also have a patient navigator who will make 5
      home visits to review materials, help patients and families talk about goals/values, and
      complete an advance directive, all in a culturally and linguistically appropriate manner. The
      navigator may also help with: accessing community resources, participating in family meetings
      with health care providers, and offering support to patients and families. The investigators
      hypothesize that the intervention will increase advance care planning, improve pain
      management, increase hospice referrals, and patients will have improved palliative care
      overall at the end of life. The patient navigator model has demonstrated an ability to
      improve cancer screening, early diagnosis, treatment, and survivorship. Once the
      investigators demonstrate the efficacy of a patient navigator intervention to improve
      palliative care for advanced cancer patients, they can disseminate the training and
      intervention to all patient navigators working with Latino cancer patients.
    

Intervention name(s): Navigation
Intervention type(s): Behavioral
Intervention description(s): As per Arm description
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Cancer; Palliative Care; Patient Navigation