Cancer is the leading cause of death among Latinos in the US and the absolute number of individuals at risk for, and dying from cancer will increase over the coming decades as the population ages. Within this aging population, Latinos are the largest and fastest growing minority group. Although little research exists, there is evidence that Latino cancer caregivers have worse outcomes including more depression and poorer quality of life in bereavement. Studies have shown that hospices can provide better care and less stress for the caregiver than hospitals or unsupported home care. Unfortunately hospice use is low and only 2% to 6% of hospice patients are Latino. ? ? We are currently completing a qualitative study comparing Latino and White bereaved cancer caregivers who have used hospice to those who have not. Our results indicate that cultural factors, such as a collectivist orientation and social networks are key determinants of hospice use. In addition, there is a lack of knowledge about hospice services and little awareness of the availability of services. Based on these results, we have designed an intervention using a trained bi-lingual and bi-cultural Lay Health Worker (LHW) to deliver information and counseling about """"""""care that may be needed in the future"""""""" and to help families navigate to hospice services, other community resources, and grief support. The LHW will also do community education to enhance understanding of hospice services. ? ? The study is designed to pilot the feasibility of prospectively enrolling 40 terminally ill patients and their caregivers. Patients and families will be identified by collaborating physicians. Twenty will receive the intervention; they will be compared to 20 who will receive usual care and print materials. Outcome measures include: number of days of hospice use; knowledge of hospice; satisfaction with care. In addition we will perform a process evaluation of the intervention including both qualitative and quantitative analyses of process variables. Evidence of a feasible and effective intervention will provide a model of care for use with Latinos nationally and with other ethnic groups. ? ? Physicians will be asked to identify Latino patients with ECOG scores of 3 or 4 and to ask if they or their caregiver would agree to talk with the study RA. The patient can be at any stage of care, including curative treatment, and need not be ready for hospice referral. The information provided by the study is about """"""""the availability of care in the future, should it be needed."""""""" Prognosis and current treatment will not be discussed. One reason for this approach is that we don't want to interfere with the current plan of care; the other is that we are sensitive to the cultural norms of not discussing prognosis with patients. ? ? Our RA will introduce the study and ask for participation. If the family agrees, they will be interviewed at baseline then selected for an intervention or control group. In the intervention group, they will be assigned a trained bi-lingual and bi-cultural counselor to inform them about future care options: palliative care, home hospice, inpatient hospice. They will also receive counseling, if necessary, and help accessing hospice care and other community services such as Meals on Wheels. The counselor will be available throughout caregiving and during bereavement, helping caregivers access bereavement services. Control families will receive usual care and written materials. ? ? ? ?
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