# I TITRATE PC: An Implementation based Community Health Worker Intervention to address Disparities in Palliative Care

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2022 · $816,621

## Abstract

SUMMARY
Palliative care can reduce physical and psychological symptoms, improve quality of life, and ensure goal-
concordant care at the end-of-life for patients with advanced cancer. There are persistent and worsening
disparities in end-of-life outcomes for African American patients which are confounded by the lower likelihood of
this population to access and receive palliative care. The basis for these disparities are multi-factorial, and at the
end of life, barriers include personal or cultural values in conflict with hospice philosophy, a lack of awareness of
hospice services, concern about burdening family, economic factors, and/or mistrust of the healthcare system.
The addition of individuals to the care team with a nuanced skillset focused on addressing such barriers to care
is a promising approach to enhance palliative care uptake. Community Health Workers (CHWs) are non-clinician,
culturally competent public health workers whose role is to promote access to services, provide health education,
support care delivery, and promote advocacy in underserved populations. CHWs supplement care for patients
with advanced chronic diseases, including HIV/AIDS, tuberculosis, and cancer, and their impact on improving
care in these settings is well-established. We developed an integrated CHW model – An Implementation based
Community Health Worker Intervention to Address Disparities in Palliative Care (I TITRATE PC) – that utilizes
CHWs as care team members to augment palliative care outcomes for underserved patients with advanced-
stage illnesses. In I TITRATE PC, CHWs are trained to provide advocacy, support, motivation, empowerment,
and education regarding palliative and end-of-life care to patients and their caregivers. Our preliminary
experience suggests that CHWs can improve palliative care outcomes and improve patient and caregiver
satisfaction with care.
Our long-term goal is to reduce disparities in palliative care for African Americans with advanced cancer.
Integration of CHWs as members of the healthcare team may be an effective means to improve access to and
enhance the uptake of palliative care in this population. To explore this, we will conduct a randomized
effectiveness-implementation pragmatic trial at four diverse cancer centers to 1. compare the effectiveness of
the I TITRATE PC intervention versus standard care in improving palliative care outcomes, including quality of
life, receipt of quality communication, advance care planning documentation/discussion, and hospice use, and
2. evaluate contextual factors that influence the effectiveness, fidelity, and adoption of the I TITRATE PC
intervention. We anticipate this work will establish the effectiveness of a CHW-based palliative care intervention
in a priority population and generate generalizable knowledge to guide the development and implementation of
interventions to increase the use of palliative care services in underserved populations.

## Key facts

- **NIH application ID:** 10345787
- **Project number:** 1R01MD016935-01
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Fabian M Johnston
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $816,621
- **Award type:** 1
- **Project period:** 2022-07-20 → 2027-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10345787

## Citation

> US National Institutes of Health, RePORTER application 10345787, I TITRATE PC: An Implementation based Community Health Worker Intervention to address Disparities in Palliative Care (1R01MD016935-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10345787. Licensed CC0.

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