Apoyo con Carino A Qualitative Analysis of a Palliative Care-Focused Lay Patient Navigation Intervention for Hispanics With Advanced Cancer
Apoyo con Carino A Qualitative Analysis of a Palliative Care-Focused Lay Patient Navigation Intervention for Hispanics With Advanced Cancer
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DOI：
10.1097/njh.0000000000000666
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发表时间：
2020-08-01
影响因子：
1.8
通讯作者：
Fischer, Stacy M.
中科院分区：
文献类型：
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作者：
Fink, Regina M.;Kline, Danielle M.;Fischer, Stacy M.
在科罗拉多的3个城市和5个农村癌症中心测试了一种非专业患者导航模型，该模型涉及文化定制的干预措施，以改善晚期癌症西班牙裔患者的姑息治疗结局。在3个月内，对112名随机对照试验干预组的患者进行了5次家访，以西班牙裔核心价值观为基础，访问涉及姑息治疗领域（提前护理计划，疼痛/症状管理和临终关怀利用）。为了描述患者导航员与患者/家庭护理人员的访视内容，研究团队成员分析了4名患者导航员的现场记录，包括对112名患者的499次访视。基于先前的工作，先验地建立代码以识别患者导航器帮助患者/家庭护理人员的方式。使用ATLAS.ti和建立的附加代码将来自现场记录的关键词和评论分类为主题。九个共同的主题和范例描述外行病人导航员的作用：激活/授权，宣传，意识，访问，建立融洽关系，提供支持，探索障碍，症状筛查，和病人的经验。患者导航员使用宣传，激活，教育和动机访谈，以解决患者/家庭的关注，并减少城市和农村环境中的高质量姑息治疗的障碍。在不同文化中调整和实施这一模式有可能改善服务不足人群的姑息治疗。
A lay patient navigator model involving a culturally tailored intervention to improve palliative care outcomes for Hispanics with advanced cancer was tested across 3 urban and 5 rural cancer centers in Colorado. Five home visits were delivered over 3 months to 112 patients assigned to the randomized controlled trial's intervention arm. Grounded in core Hispanic values, visits addressed palliative care domains (advance care planning, pain/symptom management, and hospice utilization). To describe the content of patient navigator visits with patients/family caregivers, research team members analyzed 4 patient navigators' field notes comprising 499 visits to 112 patients. Based on previous work, codes were established a priori to identify ways patient navigators help patients/family caregivers. Key words and comments from field notes were classified into themes using ATLAS.ti and additional codes established. Nine common themes and exemplars describing the lay patient navigator role are described: activation/empowerment, advocacy, awareness, access, building rapport, providing support, exploring barriers, symptom screening, and the patient experience. Patient navigators used advocacy, activation, education, and motivational interviewing to address patient/family concerns and reduce barriers to quality palliative care in urban and rural settings. Adapting and implementing this model across cultures has potential to improve palliative care access to underserved populations.