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

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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.

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