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

Rocque, Gabrielle Betty; Dionne‐Odom, J. Nicholas; Huang, Chao-Hui; Niranjan, Soumya J.; Williams, Courtney; Jackson, Bradford E.; Halilova, Karina I.; Kenzik, Kelly; Bevis, Kerri S.; Wallace, Audrey S.; Lisovicz, Nedra; Pisu, Maria; Partridge, Edward E.; Briggs, Linda; Kvale, Elizabeth; Jackson, Lee Anderson; Scott, Zoë; Cantuaria, Guilherme; Bickes, Debbie; Berry, Tina; Reiss, George R.; Mai, Hang; Chang, Ming; Gomez, Louiz; Meeker, Rhonda; Clarkson, James; Clarkson, Maggie; Stokes, Steven H.; Newman, Tina; Sheffield, Mary E.; Spremulli, Ellen N.; Watson, Wendy; Payne, Tom; Bright, Hanna; Holman, Stacey; Butler, Thomas W.; Tinnea, Cathy; Schnell, Frederick J.; Pyle, Cyndi; Taylor, Richard A.; Acemgil, Aras; Li, Xuelin; Demark‐Wahnefried, Wendy; Meneses, Karen; Li, Yufeng; Martin, Michelle Y.; Chambless, Carol; Pacheco-Rubi, Valeria; Salter, Terri; Smedley, Warren; Fouad, Mona N.

doi:10.1016/j.jpainsymman.2016.11.012

Cited by 87 publications

(141 citation statements)

References 36 publications

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“…Interestingly, of clients where ACP was initiated but incomplete, one-third reported they were in progress. Similar observations over the same time period have been made elsewhere 26. It is reasonable to suppose that over time ACP completion rates might be higher.…”

Section: Discussionsupporting

confidence: 82%

Prospective comparative effectiveness cohort study comparing two models of advance care planning provision for Australian community aged care clients

Detering

Carter²,

Sellars

et al. 2017

BMJ Support Palliat Care

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Objectives Conduct a prospective comparative effectiveness cohort study comparing two models of advance care planning (ACP) provision in community aged care: ACP conducted by the client's case manager (CM) ('Facilitator') and ACP conducted by an external ACP service ('Referral') over a 6-month period. Methods This Australian study involved CMs and their clients. Eligible CM were English speaking, ≥18 years, had expected availability for the trial and worked ≥3 days per week. CMs were recruited via their organisations, sequentially allocated to a group and received education based on the group allocation. They were expected to initiate ACP with all clients and to facilitate ACP or refer for ACP. Outcomes were quantity of new ACP conversations and quantity and quality of new advance care directives (ACDs). results 30 CMs (16 Facilitator, 14 Referral) completed the study; all 784 client's files (427 Facilitator, 357 Referral) were audited. ACP was initiated with 508 (65%) clients (293 Facilitator, 215 Referral; p<0.05); 89 (18%) of these (53 Facilitator, 36 Referral) and 41 (46%) (13 Facilitator, 28 Referral; p<0.005) completed ACDs. Most ACDs (71%) were of poor quality/ not valid. A further 167 clients (facilitator 124; referral 43; p<0.005) reported ACP was in progress at study completion. conclusions While there were some differences, overall, models achieved similar outcomes. ACP was initiated with 65% of clients. However, fewer clients completed ACP, there was low numbers of ACDs and document quality was generally poor. The findings raise questions for future implementation and research into community ACP provision. IntrOductIOnAdvance care planning (ACP) is a coordinated communication process between a person, their family/carer(s) and healthcare providers and aims to clarify the person's values, treatment preferences and goals of medical treatment should the person lose capacity to make or communicate such decisions in the future. 1 In Australia, formal ACP programmes usually operate within health, institutional or aged care settings and involve trained staff.1 These programmes are often located at public health services. While discussions are the main focus, an important and often desirable outcome of ACP is the completion of a written advance care directive (ACD) that documents the person's preferences and/or the appointment of a substitute decision maker.1 ACP has been shown to improve care, including end-of-life care, 2 3 to improve the likelihood that a person's preferences will be known and respected [2][3][4] and to improve the psychological outcomes in surviving relatives. The Australian Government Home Care Package (HCP) programme provides funding for personal/health/nursing support to frail or unwell Australians to assist them to remain at home rather than enter residential care. 5 HCPs assisted 60 000 people in 2013; this number is expected to increase to 100 000 by Research 2016/2017, with predictions that 80% of aged care services will be delivered in this form by 2050.5 Each client i...

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Section: Discussionsupporting

confidence: 82%

Prospective comparative effectiveness cohort study comparing two models of advance care planning provision for Australian community aged care clients

Detering

Carter²,

Sellars

et al. 2017

BMJ Support Palliat Care

View full text Add to dashboard Cite

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“…Six articles examined the efficacy of PN for survivorship, and 5 of them (83%) included breast cancer . Two studies reported that PN interventions significantly improved cancer‐specific well‐being, emotional well‐being, and quality of life .…”

Section: Resultsmentioning

confidence: 99%

“…Two studies reported that PN interventions significantly improved cancer‐specific well‐being, emotional well‐being, and quality of life . Other studies showed that PN interventions resulted in higher rates of attendance to medical appointments, lower rates of hospitalization, and fewer intensive care unit admissions and emergency room visits . However, 1 study observed no difference in satisfaction with cancer‐related care between PN and usual care .…”

Section: Resultsmentioning

confidence: 99%

“…109,118,119 Survivorship Six articles examined the efficacy of PN for survivorship, and 5 of them (83%) included breast cancer. [122][123][124][125][126][127] Two studies reported that PN interventions significantly improved cancer-specific well-being, emotional well-being, and quality of life. 123,124 Other studies showed that PN interventions resulted in higher rates of attendance to medical appointments, lower rates of hospitalization, and fewer intensive care unit admissions and emergency room visits.…”

Section: Treatmentmentioning

confidence: 99%

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The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

Bernardo

Zhang

Hery

et al. 2019

Cancer

136

166

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Published studies regarding patient navigation (PN) and cancer were reviewed to assess quality, determine gaps, and identify avenues for future research. The PubMed and EMBASE databases were searched for studies investigating the efficacy and cost‐effectiveness of PN across the cancer continuum. Each included article was scored independently by 2 separate reviewers with the Quality Assessment Tool for Quantitative Studies. The current review identified 113 published articles that assessed PN and cancer care, between August 1, 2010, and February 1, 2018, 14 of which reported on the cost‐effectiveness of PN programs. Most publications focused on the effectiveness of PN in screening (50%) and diagnosis (27%) along the continuum of cancer care. Many described the effectiveness of PN for breast cancer (52%) or colorectal cancer outcomes (51%). Most studies reported favorable outcomes for PN programs, including increased uptake of and adherence to cancer screenings, timely diagnostic resolution and follow‐up, higher completion rates for cancer therapy, and higher rates of attending medical appointments. Cost‐effectiveness studies showed that PN programs yielded financial benefits. Quality assessment showed that 75 of the 113 included articles (65%) had 2 or more weak components. In conclusion, this review indicates numerous gaps within the PN and cancer literature where improvement is needed. For example, more research is needed at other points along the continuum of cancer care outside of screening and diagnosis. In addition, future research into the effectiveness of PN for understudied cancers outside of breast and colorectal cancer is necessary along with an assessment of cost‐effectiveness and more rigorous reporting of study designs and results in published articles.

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“…Lay (nonclinical) patient navigators are seen in the US cancer care system to “provide emotional support, information, opportunities for problem‐solving, and logistical assistance to mitigate or overcome obstacles to health” (Rocque et al, , p. 683). There are also Native Patient Navigators, described as working successfully with American Indians to improve health behaviours in the “Native Navigators and the Cancer Continuum study” (Burhansstipanov et al, ).…”

Section: Introductionmentioning

confidence: 99%

What role do Death Doulas play in end‐of‐life care? A systematic review

Rawlings

Tieman

Miller-Lewis

et al. 2018

Health Soc Care Community

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Current health and social care systems do not always meet the needs of the dying in our communities. As a result, patients and families are choosing to place their trust in those who can advocate for them or fill the gaps in care. Birth Doulas have been working with women during pregnancy and after birth for many years, and we are now seeing a new role, that of a Death Doula emerging in the end‐of‐life care space. How Death Doulas work within health and social care systems is not understood and we conducted a systematic review to explore the published literature to explore the role and potential implications for models of care delivery. Following the PRISMA recommendations, we searched the literature in January 2018 via bibliographic databases and the grey literature without search date parameters to capture all published literature. We looked for articles that describe the role/work of a death doula or a death midwife in the context of end‐of‐life care, or death and dying. Our search retrieved 162 unique records of which five papers were included. We analysed the papers in relation to relationship to health service, funding source, number and demand for services, training, licensing and ongoing support, and tasks undertaken. Death Doulas are working with people at the end of life in varied roles that are still little understood, and can be described as similar to that of “an eldest daughter” or to a role that has similarities to specialist palliative care nurses. Death doulas may represent a new direction for personalised care directly controlled by the dying person, an adjunct to existing services, or an unregulated form of care provision without governing oversight.

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

Abstract: A navigator-led ACP program was feasible and may be associated with lower rates of resource utilization near EOL.

Cited by 87 publications

References 36 publications

Prospective comparative effectiveness cohort study comparing two models of advance care planning provision for Australian community aged care clients

Prospective comparative effectiveness cohort study comparing two models of advance care planning provision for Australian community aged care clients

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

What role do Death Doulas play in end‐of‐life care? A systematic review

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