Dissemination and Implementation of a Community Health Worker Intervention for Disparities in Palliative Care (DeCIDE PC): a study protocol for a hybrid type 1 randomized controlled trial.
Dissemination and Implementation of a Community Health Worker Intervention for Disparities in Palliative Care (DeCIDE PC): a study protocol for a hybrid type 1 randomized controlled trial.
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DOI：
10.1186/s12904-023-01250-0
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发表时间：
2023-09-18
影响因子：
3.1
通讯作者：
Johnston, Fabian M.
中科院分区：
文献类型：
--
作者：
Siddiqi, Amn;Monton, Olivia;Woods, Alison;Masroor, Taleaa;Fuller, Shannon;Owczarzak, Jill;Yenokyan, Gayane;Cooper, Lisa A.;Freund, Karen M.;Smith, Thomas J.;Kutner, Jean S.;Colborn, Kathryn L.;Joyner, Robert;Elk, Ronit;Johnston, Fabian M.
关键词：
在美国，在临终健康结果方面存在持续的种族和民族健康差异。与白色患者相比，非裔美国患者不太可能获得姑息治疗，参加临终关怀，与医疗保健提供者讨论护理目标，获得充分的症状控制或在家中死亡。我们开发了社区卫生工作者干预姑息治疗差异（DecIDE PC），以解决这些差异。DeCIDE PC是一种综合社区卫生工作者（CHW）姑息治疗干预措施，使用社区卫生工作者（CHW）作为护理团队成员，以提高晚期癌症非裔美国人接受姑息治疗的能力。本研究的总体目标是（1）评估DeCIDE PC干预在改善晚期实体器官恶性肿瘤非裔美国患者及其非正式护理人员姑息治疗结局方面的有效性，以及（2）开发关于背景因素如何影响实施的可推广知识，以促进干预的传播，吸收和可持续性。我们将在美国的三个癌症中心进行一项多中心、随机、评估者盲法、平行组、务实、混合1型有效性实施试验。将在6个月内提供DeCIDE PC干预，并根据患者和护理人员的个人需求提供CHW支持。主要结果将是提前护理计划。将使用逻辑回归对治疗效应进行建模。次要结果是生活质量、沟通质量、临终关怀利用率和患者症状。我们希望DeCIDE PC干预能够改善姑息治疗的整合，减少多层次的护理障碍，加强诊所和患者与资源的联系，并最终改善非洲裔美国晚期癌症患者的姑息治疗结果。DeCIDE PC干预可能是一种变革性的模式，有可能指导大规模的大规模采用有希望的战略，以改善姑息治疗的使用，并减少美国晚期癌症非裔美国人临终关怀的差异。在ClinicalTrials.gov上注册（NCT 05407844）。首次发布于2022年6月7日。
There are persistent racial and ethnic health disparities in end-of-life health outcomes in the United States. African American patients are less likely than White patients to access palliative care, enroll in hospice care, have documented goals of care discussions with their healthcare providers, receive adequate symptom control, or die at home. We developed Community Health Worker Intervention for Disparities in Palliative Care (DeCIDE PC) to address these disparities. DeCIDE PC is an integrated community health worker (CHW) palliative care intervention that uses community health workers (CHWs) as care team members to enhance the receipt of palliative care for African Americans with advanced cancer. The overall objectives of this study are to (1) assess the effectiveness of the DeCIDE PC intervention in improving palliative care outcomes amongst African American patients with advanced solid organ malignancy and their informal caregivers, and (2) develop generalizable knowledge on how contextual factors influence implementation to facilitate dissemination, uptake, and sustainability of the intervention. We will conduct a multicenter, randomized, assessor-blind, parallel-group, pragmatic, hybrid type 1 effectiveness-implementation trial at three cancer centers across the United States. The DeCIDE PC intervention will be delivered over 6 months with CHW support tailored to the individual needs of the patient and caregiver. The primary outcome will be advance care planning. The treatment effect will be modeled using logistic regression. The secondary outcomes are quality of life, quality of communication, hospice care utilization, and patient symptoms. We expect the DeCIDE PC intervention to improve integration of palliative care, reduce multilevel barriers to care, enhance clinic and patient linkage to resources, and ultimately improve palliative care outcomes for African American patients with advanced cancer. If found to be effective, the DeCIDE PC intervention may be a transformative model with the potential to guide large-scale adoption of promising strategies to improve palliative care use and decrease disparities in end-of-life care for African American patients with advanced cancer in the United States. Registered on ClinicalTrials.gov (NCT05407844). First posted on June 7, 2022.
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影响因子：
4.7
作者：
O'Mara, Ann M.;Germain, Diane St.;Bornemann, Tami
通讯作者：
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影响因子：
1.6
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Smith, Thomas J.
影响因子：
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Hunt, Bijou R.;Allgood, Kristi;Whitman, Steve
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Jacobsen, P