Implementation and Impact of Patient Lay Navigator-led Advance Care Planning Conversations

Autor: Gabrielle B. Rocque, J. Nicholas Dionne-Odom, Chao-Hui Sylvia Huang, Soumya J. Niranjan, Courtney P. Williams, Bradford E. Jackson, Karina I. Halilova, Kelly M. Kenzik, Kerri S. Bevis, Audrey S. Wallace, Nedra Lisovicz, Richard A. Taylor, Maria Pisu, Edward E. Partridge, Thomas W. Butler, Linda A. Briggs, Elizabeth A. Kvale, Lee Jackson, Zoe Scott, Guilherme Cantuaria, Debbie Bickes, Tina Berry, George Reiss, Hang Mai, Ming Chang, Louiz Gomez, Rhonda Meeker, James Clarkson, Maggie Clarkson, Steven Stokes, Tina Newman, Mary Sheffield, Ellen Spremulli, Wendy Watson, Tom Payne, Hanna Bright, Stacey Holman, Thomas Butler, Cathy Tinnea, Fred Schnell, Cyndi Pyle, Richard Taylor, Aras Acemgil, Xuelin Li, Wendy Demark-Wahnefried, Karen Meneses, Yufeng Li, Michelle Y. Martin, Carol Chambless, Valeria Pacheco-Rubi, Terri L. Salter, Warren Smedley, Mona Fouad
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Popis: CONTEXT: Advance care planning (ACP) improves alignment between patient preferences for life-sustaining treatment and care received at end of life (EOL). OBJECTIVES: To evaluate implementation of lay navigator-led ACP. METHODS: A convergent, parallel mixed-methods design was employed to evaluate implementation of navigator-led ACP across 12 cancer centers. Data collection included: (1) electronic navigation records, (2) navigator surveys (n=45), (3) claims-based patient outcomes (n=820), and (4) semi-structured navigator interviews (n=26). Outcomes of interest included (1) the number of ACP conversations completed, (2) navigator self-efficacy, (3) patient resource utilization, hospice use, and chemotherapy at EOL, and (4) navigator-perceived barriers and facilitators to ACP. RESULTS: From 6/1/14–12/31/15, 50 navigators completed Respecting Choices® First Steps ACP Facilitator training. Navigators approached 18% (1319/8704) of patients; 481 completed; 472 in process; 366 declined. Navigators were more likely to approach African American patients than Caucasian patients (20% vs. 14%, p < 0.001). Significant increases in ACP self-efficacy were observed after training. The mean score for feeling prepared to conduct ACP conversations increased from 5.6/10 to 7.5/10 (p
Databáze: OpenAIRE
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