Details

Autor(en) / Beteiligte

• Rocque, Gabrielle B., MD
• Dionne-Odom, J. Nicholas, PhD, RN
• Sylvia Huang, Chao-Hui, PhD
• Niranjan, Soumya J., BPharm, MS
• Williams, Courtney P., MPH
• Jackson, Bradford E., PhD
• Halilova, Karina I., MD, MPH
• Kenzik, Kelly M., PhD
• Bevis, Kerri S., MD
• Wallace, Audrey S., MD, MSN
• Lisovicz, Nedra, PhD, MPH, CHES
• Taylor, Richard A., DNP, CRNP, ANP-BC
• Pisu, Maria, PhD
• Partridge, Edward E., MD
• Briggs, Linda A., MSN, MA, RN
• Kvale, Elizabeth A., MD

Titel

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

Ist Teil von

• Journal of pain and symptom management, 2017-04, Vol.53 (4), p.682-692

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2017

Quelle

Applied Social Sciences Index & Abstracts (ASSIA)

Beschreibungen/Notizen

• Abstract 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 <.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<.001). In comparison to patients declining ACP participation (n=171), decedents in their final 30 days of life who engaged in ACP (n=437) had fewer hospitalizations (46% vs 56%, p=0.02). Key facilitators of successful implementation included physician buy-in, patient readiness and prior ACP experience; barriers included space limitations, identifying the “right” time to start conversations, and personal discomfort discussing EOL. Conclusion and Relevance A navigator-led ACP program was feasible and may be associated with lower rates of resource utilization near EOL.