Manali I Patel1,2,3, David Moore4, Tumaini R Coker5,6. 1. 1 Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA. 2. 2 Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA. 3. 3 Center for Primary Care and Outcomes Research, Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA. 4. 4 Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA. 5. 5 Seattle Children's Hospital, Seattle Children's Research Institute, Seattle, WA, USA. 6. 6 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
Abstract
IMPORTANCE: The Engagement of Patients with Advanced Cancer (EPAC), comprised of a lay health worker (LHW) who assists patients with advance care planning, is an effective intervention for improving patient experiences and reducing acute care use and total health-care costs. The objective of this study was to assess patients' and caregivers' experiences with the intervention. METHODS: We invited all patients enrolled in EPAC and their caregivers to complete an 8-item survey at the end of the intervention and a random 35% sample to participate in a qualitative interview to assess their experiences. At 15-month follow-up, we invited all caregivers of patients who died during the study to participate in a qualitative interview. We analyzed survey responses using bivariate methods and recorded, transcribed, and analyzed interviews using qualitative content analysis. RESULTS: Sixty-nine patients were alive at completion of the intervention and all 30 identified caregivers completed the survey. All viewed the intervention as a critical part of cancer care and recommended the intervention for other patients. In qualitative interviews, among 30 patients, all reported improved comfort in discussing their end-of-life care preferences. In qualitative interviews with 24 bereaved caregivers, all viewed the intervention as critical in ensuring that their loved ones' wishes were adhered to at the end of life. CONCLUSIONS AND RELEVANCE: Incorporating an LHW into end-of-life cancer care is an approach supported and viewed as highly effective in improving care by patients and caregivers. The LHW-led EPAC intervention is one solution that can significantly impact patient and caregiver experiences.
IMPORTANCE: The Engagement of Patients with Advanced Cancer (EPAC), comprised of a lay health worker (LHW) who assists patients with advance care planning, is an effective intervention for improving patient experiences and reducing acute care use and total health-care costs. The objective of this study was to assess patients' and caregivers' experiences with the intervention. METHODS: We invited all patients enrolled in EPAC and their caregivers to complete an 8-item survey at the end of the intervention and a random 35% sample to participate in a qualitative interview to assess their experiences. At 15-month follow-up, we invited all caregivers of patients who died during the study to participate in a qualitative interview. We analyzed survey responses using bivariate methods and recorded, transcribed, and analyzed interviews using qualitative content analysis. RESULTS: Sixty-nine patients were alive at completion of the intervention and all 30 identified caregivers completed the survey. All viewed the intervention as a critical part of cancer care and recommended the intervention for other patients. In qualitative interviews, among 30 patients, all reported improved comfort in discussing their end-of-life care preferences. In qualitative interviews with 24 bereaved caregivers, all viewed the intervention as critical in ensuring that their loved ones' wishes were adhered to at the end of life. CONCLUSIONS AND RELEVANCE: Incorporating an LHW into end-of-life cancer care is an approach supported and viewed as highly effective in improving care by patients and caregivers. The LHW-led EPAC intervention is one solution that can significantly impact patient and caregiver experiences.
Entities:
Keywords:
cancer care; caregiver; end of life; patient experiences
Authors: Manali I Patel; Vyjeyanthi S Periyakoil; David Moore; Andrea Nevedal; Tumaini R Coker Journal: Am J Hosp Palliat Care Date: 2017-07-10 Impact factor: 2.500
Authors: Jane C Weeks; Paul J Catalano; Angel Cronin; Matthew D Finkelman; Jennifer W Mack; Nancy L Keating; Deborah Schrag Journal: N Engl J Med Date: 2012-10-25 Impact factor: 91.245
Authors: Baohui Zhang; Alexi A Wright; Haiden A Huskamp; Matthew E Nilsson; Matthew L Maciejewski; Craig C Earle; Susan D Block; Paul K Maciejewski; Holly G Prigerson Journal: Arch Intern Med Date: 2009-03-09
Authors: Manali I Patel; Vyjeyanthi S Periyakoil; Douglas W Blayney; David Moore; Andrea Nevedal; Steven Asch; Arnold Milstein; Tumaini R Coker Journal: J Oncol Pract Date: 2017-02-07 Impact factor: 3.714