Apoyo con Cariño: A Pilot Randomized Controlled Trial of a Patient Navigator Intervention to Improve Palliative Care Outcomes for Latinos With Serious Illness

Abstract

Context Latinos experience significant health disparities at the end of life compared with non-Latinos. Objectives To determine the feasibility of a patient navigator intervention to improve palliative care outcomes for Latino adults with serious illness. Methods This was a pilot randomized controlled trial that included 64 Latino adults with life-limiting illness randomized to an intervention or control group. All participants received a packet of linguistically matched materials on palliative care. In addition, intervention participants received up to five home visits from the bilingual, bicultural patient navigator. Visits focused on addressing barriers to palliative care through education, activation, and culturally tailored messaging. Outcomes included feasibility and advance care planning rates, documentation of pain management discussions in the medical record, and hospice utilization. Results Of the 32 patients randomized to the intervention arm, 81% had at least one home visit (range 1–5) with the patient navigator. Overall, advance care planning was higher in the intervention group – 47% (n = 15) vs. 25% (n = 8) (P=0.06), and 79% of intervention participants had a discussion about pain management documented in their medical record vs. 54% of control patients (P = 0.05). Hospice enrollment between the two groups (n=18 decedents) was similar (n=7 intervention vs. n=6 control; length of stay in the intervention group was 36.4± 51.6 days vs. 19.7±33.6 days for control patients (P = 0.39). Conclusion A culturally tailored patient navigator intervention was feasible and suggests improved palliative care outcomes for Latinos facing advanced medical illness, justifying a fully powered randomized controlled trial.

Qualitative Interviews Exploring Palliative Care Perspectives of Latinos on Dialysis

“…A culturally and linguistically congruent approach to reduce palliative care disparities is patient navigation (29). Community-based navigators were first utilized to improve cancer care, and, more recently, demonstrated to improve palliative care outcomes among Latinos (30)(31)(32). An ESRD-focused navigator could address the barriers described by our participants: by having ACP conversations at home including family, leading ACP conversations to avoid patient-family tension, describing palliative care options to overcome communication and health literacy barriers, and by providing person-centered care in a culturally responsive way.…”

The Influence of Race/Ethnicity and Education on Family Ratings of the Quality of Dying in the ICU

“…For instance, previous study of ratings of satisfaction with physician communication as a measure of quality of end-of-life care found racial/ethnic differences mediated by socioeconomic status [44], suggesting that the influence of race/ethnicity and education may vary depending on the specific assessment of quality of care used. Importantly, because many recommendations to eliminate racial and ethnic disparities in health care in general [45], and end of life care specifically [18, 46], have focused on improving patient education and knowledge, it is important to continue to explore the role educational attainment, along with health literacy, may play in assessments of quality of end-oflife care. This exploration would benefit from the addition of other measures assessing quality of end-of-life care (e.g.…”

Eliminating Health Disparities through Action on the Social Determinants of Health: A Systematic Review of Home Visiting in the United States, 2005–2015

“…The prevention categories (Table ) of the research articles included in this section were Respiratory ( n = 6), Adult Health ( n = 5), Maternal/Infant Health ( n = 2), and Environment/Safety ( n = 1). Nine of the articles in the tertiary prevention grouping included a nurse author (Brown, Reeves, Meyerson, & Korzeniewski, ; Brown, McLaine, Dixon, & Simon, ; Butz et al., ; Creber et al., ; Dunbar et al., ; Fischer, Cervantes, Fink, & Kutner, ; Horner & Brown, ; Williams et al., ; Woods et al., ) (Table ).…”

“…There were four studies that had experimental designs in the Adult Health category (Table ). One article described a tertiary care intervention that included home visits by PP/CHWs to teach palliative care strategies that enhance quality of life for people with cancer (Fischer et al., ) (Table ). A study by Williams et al.…”

“…Public Health Nursing Volume 34 Number 1 January/February 2017 the articles in the tertiary prevention grouping included a nurse author (Brown, Reeves, Meyerson, & Korzeniewski, 2006a;Brown, McLaine, Dixon, & Simon, 2006b;Butz et al, 2005;Creber et al, 2015;Dunbar et al, 2015;Fischer, Cervantes, Fink, & Kutner, 2015;Horner & Brown, 2014;Williams et al, 2006;Woods et al, 2012) (Table 1). The six articles in the Respiratory category involved experimental (n = 5) and one quasiexperimental studies targeting asthma (Table 1).…”