Effect of a Lay Health Worker Intervention on Goals-of-Care Documentation and on Health Care Use, Costs, and Satisfaction Among Patients With Cancer

Patel, Manali I.; Sundaram, Vandana; Desai, Manisha; Periyakoil, Vyjeyanthi S.; Kahn, James S.; Bhattacharya, Jay; Asch, Steven M.; Milstein, Arnold; Bundorf, M. Kate

doi:10.1001/jamaoncol.2018.2446

Cited by 91 publications

(148 citation statements)

References 41 publications

(67 reference statements)

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“…A recent intervention using a lay facilitator demonstrated statistically significant differences in goals of care documentation, overall rating of providers on a CAHPS measure, increased utilization of hospice in the last 30 days, and decreased hospital, emergency department utilization, and overall health care spending. 42 This approach holds promise, yet communication of prognosis was outside the scope of this intervention. Other participants proposed that SIC should be clinician led because they are best positioned to help patients understand their prognosis and treatment options and can most effectively translate the conversation into care planning.…”

Section: Challenges Recommendations and Future Researchmentioning

confidence: 99%

Quality Measurement of Serious Illness Communication: Recommendations for Health Systems Based on Findings from a Symposium of National Experts

Sanders

Paladino

Reaves

et al. 2020

Journal of Palliative Medicine

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Background: Communication between clinicians and patients fundamentally shapes the experience of serious illness. There is increasing recognition that health systems should routinely implement structures and processes to assure high-quality serious illness communication (SIC) and measure the effectiveness of their efforts on key outcomes. The absence, underdevelopment, or limited applicability of quality measures related specifically to SIC, and their limited application only to those seen by specialist palliative and hospice care teams, hinder efforts to improve care planning, service delivery, and health outcomes for all seriously ill patients. Objective: We convened an expert stakeholder symposium and subsequently surveyed participants to consider challenges, opportunities, priorities, and strategies to improve quality measurement specific to SIC. Results: We identified several barriers and opportunities to improving quality measurement of SIC. These include issues related to the definition of SIC, methodological challenges related to measuring SIC and related outcomes, underutilization of technologies that can facilitate measurement, and measurement development, and dissemination. Conclusions: Patients, clinicians, and health systems increasingly align around the importance of highquality communication in serious illness. We offer recommendations for various stakeholder groups to advance SIC quality measurement. Enthusiasm and a sense of urgency among health systems to drive and measure communication improvements inform our proposal for a set of example measures for implementation now.

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Section: Challenges Recommendations and Future Researchmentioning

confidence: 99%

Quality Measurement of Serious Illness Communication: Recommendations for Health Systems Based on Findings from a Symposium of National Experts

Sanders

Paladino

Reaves

et al. 2020

Journal of Palliative Medicine

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“…It has been successfully utilized in numerous countries to improve access to care. Utilizing task shifting and training multiethnic CHWs to provide aging adult services is an innovative and economical way, to fulfill the large and growing need for complex illness supportive services of community‐dwelling older adults. The World Health Organization defines a community or lay health worker as a member of the community who has received some training to promote health or to carry out some healthcare services but is not a healthcare professional.…”

Section: Strategies To Improve Care Of Diverse Older Adults Within Thmentioning

confidence: 99%

“…An example of a successful training model is the Stanford In‐Reach for Successful Aging and End‐of‐Life (iSAGE) minifellowship, an 80‐hour blended learning program that combines acquisition of knowledge as well as mentored field work to acquire skills. An iSAGE‐trained CHW successfully delivered an intervention to seriously ill cancer patients that resulted in increased goals‐of‐care documentation, improved patient satisfaction, and reduction in healthcare use and costs in later years and at the end of life. A Spanish version of the iSAGE training has been developed and is being used to train “ promotoras” to assist patients in documenting what matters most to them and complete advance care planning.…”

Section: Strategies To Improve Care Of Diverse Older Adults Within Thmentioning

confidence: 99%

Building a Culturally Competent Workforce to Care for Diverse Older Adults: Scope of the Problem and Potential Solutions

Periyakoil

2019

J American Geriatrics Society

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The population of minority older adults is going to explode over the next four decades. Older adults from racial and ethnic minorities face persistent and pervasive health disparities. Health disparities exert a huge fiscal burden on the nation. The national financial cost of health disparities for the years 2002 to 2006 was an estimated 1.23 trillion dollars. As the aging population becomes more diverse, these disparity-related costs are expected to increase. Older adults from racial and ethnic minorities face multiple barriers to accessing health and support services that will help them to age and die in place in the community. Patientrelated barriers include limited English proficiency, low health literacy, varying levels of acculturation, biases about Western healthcare and medications, mistrust of clinicians, inability to navigate the complex healthcare system, and cultural beliefs and taboos. Clinician-related barriers include ageism (ie, discrimination against older people due to negative and inaccurate stereotypes), conscious and unconscious bias, being deeply entrenched in the culture of biomedicine, and the lack of training in the principles and practice of providing culturally respectful care. Health system-related barriers include lack of culturally tailored services, including access to medical interpreters. We conclude by identifying three specific strategies to facilitate culturally humble and respectful care for diverse patients.

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“…At six months, the study demonstrated greater goals of care documentation and hospice use, and lower acute care use among patients in the intervention as compared to the control. It was also found that this intervention decreased healthcare expenditure for the VA system, suggesting that this may be a cost-effective model from the perspective of the payor[ 50 ]. Further studies of lay health care worker interventions in low income populations in the United States are ongoing[ 51 , 52 ].…”

Section: Patient Navigation and Community Health Workersmentioning

confidence: 99%

Healthcare delivery interventions to reduce cancer disparities worldwide

Dickerson

Ragavan

Parikh

et al. 2020

WJCO

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Globally, cancer care delivery is marked by inequalities, where some economic, demographic , and sociocultural groups have worse outcomes than others. In this review, we sought to identify patient-facing interventions designed to reduce disparities in cancer care in both high- and low-income countries. We found two broad categories of interventions that have been studied in the current literature: Patient navigation and telehealth. Navigation has the strongest evidence base for reducing disparities, primarily in cancer screening. Improved outcomes with navigation interventions have been seen in both high- and low-income countries. Telehealth interventions remain an active area of exploration, primarily in high income countries, with the best evidence being for the remote delivery of palliative care. Ongoing research is needed to identify the most efficacious, cost-effective, and scalable interventions to reduce barriers to the receipt of cancer care globally.

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Effect of a Lay Health Worker Intervention on Goals-of-Care Documentation and on Health Care Use, Costs, and Satisfaction Among Patients With Cancer

Abstract: ClinicalTrials.gov Identifier: NCT02966509.

Cited by 91 publications

References 41 publications

Quality Measurement of Serious Illness Communication: Recommendations for Health Systems Based on Findings from a Symposium of National Experts

Quality Measurement of Serious Illness Communication: Recommendations for Health Systems Based on Findings from a Symposium of National Experts

Building a Culturally Competent Workforce to Care for Diverse Older Adults: Scope of the Problem and Potential Solutions

Healthcare delivery interventions to reduce cancer disparities worldwide

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