Apoyo Con Carino: Patient Navigation for Palliative Care

Our 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. Our 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. We hypothesize that our 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 we demonstrate the efficacy of a patient navigator intervention to
improve palliative care for advanced cancer patients, we can disseminate the training and
intervention to all patient navigators working with Latino cancer patients.

Inclusion Criteria:

- Stage III or Stage IV cancer (all types)

- Self-identify as Latino

- 18 years of age or older

- Speak English or Spanish

Exclusion Criteria:

- Lacking decisional capacity

- Incarcerated