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.
Latinos with end-stage renal disease and limited English proficiency in the U.S. are disproportionately affected by depressive affect and social challenges. Depressive affect among patients with end-stage renal disease is associated with reduced renal therapy adherence, greater morbidity, and increased mortality. In this study, we plan to explore a culturally tailored intervention that will address social challenges and depressive affect to improve patient-centered and clinical outcomes among Latino patients with end-stage renal disease and limited English proficiency.
