Effect of Apoyo con Carino (Support With Caring) Trial of a Patient Navigator Intervention to Improve Palliative Care Outcomes for Latino Adults With Advanced Cancer A Randomized Clinical Trial
Effect of Apoyo con Carino (Support With Caring) Trial of a Patient Navigator Intervention to Improve Palliative Care Outcomes for Latino Adults With Advanced Cancer A Randomized Clinical Trial
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DOI：
10.1001/jamaoncol.2018.4014
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发表时间：
2018-12-01
期刊：
影响因子：
28.4
通讯作者：
Fink, Regina M.
中科院分区：
文献类型：
--
作者：
Fischer, Stacy M.;Kline, Danielle M.;Fink, Regina M.
重要性战略，以增加获得姑息治疗，特别是对种族/少数民族，必须最大限度地提高初级姑息治疗和社区为基础的模式，以满足日益增长的需要，在文化敏感和一致的marty.OBJECTIVE调查，如果一个文化定制的病人导航干预可以改善姑息治疗的结果为拉丁美洲成年人晚期癌症。Apoyo con Carino（支持与关怀）随机临床试验于2012年7月至2016年3月进行。研究的背景是遍布科罗拉多州的诊所，包括一个学术性的国家癌症研究所指定的癌症中心、社区癌症诊所（城市和农村）和一个安全网癌症中心。参与者是成年人谁自认为是拉丁裔和正在接受治疗的晚期cancer.INTERVENTION文化定制的患者导航intervention.Main结局和措施Primary结局measureswere提前护理计划的医疗记录，简明疼痛量表，临终关怀的使用。次要结果指标包括麦吉尔生活质量问卷（MQOL），临终关怀住院时间，以及生命结束时的积极护理。本研究采用意向治疗设计。结果：总共有223名拉丁美洲成年人入组（平均[SD]年龄，58.1 [13.6]岁; 55.6%为女性），并随机分为对照组（n = 111）和干预组（n = 112）。与对照组患者相比，干预组患者更可能有书面的预先指示（73/112 [65.2%] vs 40/111 [36.0%]，P
IMPORTANCE Strategies to increase access to palliative care, particularly for racial/ethnic minorities, must maximize primary palliative care and community-based models to meet the ever-growing need in a culturally sensitive and congruent manner.OBJECTIVE To investigate if a culturally tailored patient navigator intervention can improve palliative care outcomes for Latino adults with advanced cancer.DESIGN, SETTING, AND PARTICIPANTS The Apoyo con Carino (Support With Caring) randomized clinical trial was conducted from July 2012 to March 2016. The setting was clinics across the state of Colorado, including an academic National Cancer Institute-designated cancer center, community cancer clinics (urban and rural), and a safety-net cancer center. Participants were adults who self-identified as Latino and were being treated for advanced cancer.INTERVENTION Culturally tailored patient navigator intervention.MAIN OUTCOMES AND MEASURES Primary outcome measureswere advance care planning in the medical record, the Brief Pain Inventory, and hospice use. Secondary outcome measures included the McGill Quality of Life Questionnaire (MQOL), hospice length of stay, and aggressiveness of care at the end of life. This study used an intent-to-treat design.RESULTS In total, 223 Latino adults enrolled (mean [SD] age, 58.1 [13.6] years; 55.6% female) and were randomized to control (n = 111) or intervention (n = 112) groups. Intervention group patients were more likely to have a documented advance directive compared with control group patients (73 of 112 [65.2%] vs 40 of 111 [36.0%], P