Dissemination and Implementation of a Community Health Worker Intervention for Disparities in Palliative Care (DeCIDE PC)

社区卫生工作者针对姑息治疗差异的干预措施的传播和实施 (DeCIDE PC)

• 批准号: 10208168
• 负责人: Fabian M Johnston
• 金额: $ 67.97万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10208168
• 关键词: AIDS/HIV problem; Address; Administrator; Adoption; Advance Care Planning; Advanced Malignant Neoplasm; Advocacy; Advocate; African American; American Society of Clinical Oncology; Awareness; Cancer Center; Caregivers; Caring; Chronic Disease; Communication; Communities; Community Health Aides; Community Healthcare; Community Integration; Complement; Conflict (Psychology); Consolidated Framework for Implementation Research; Development; Disease; Dissemination and Implementation; Documentation; Economic Factors; Education; Effectiveness; Enrollment; Ensure; Evaluation; Evidence based practice; Family; Focus Groups; Funding; Goals; Health; Health Services Accessibility; Health education; Healthcare Systems; Home; Hospice Care; Hospitals; Hybrids; Improve Access; Individual; Intervention; Interview; Investigation; Knowledge; Link; Malignant Neoplasms; Medical Care Team; Methods; Modeling; Motivation; Oncologist; Outcome; Pain management; Palliative Care; Patient Care; Patient advocacy; Patients; Philosophy; Physicians; Pilot Projects; Population; Process; Public Health; Quality of Care; Quality of life; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Resources; Role; Scanning; Services; Site; Social Work; System; Techniques; Training; Tuberculosis; Underserved Population; United States National Institutes of Health; Work; barrier to care; base; cancer care; care delivery; care outcomes; care systems; compare effectiveness; contextual factors; cultural competence; cultural values; design; disparity reduction; effectiveness-implementation randomized trial; empowered; empowerment; end of life; end of life care; evidence base; experience; family burden; health care delivery; health care disparity; high risk; hospice environment; implementation barriers; implementation facilitation; implementation intervention; improved; informant; member; palliative; physical symptom; pragmatic trial; psychological symptom; racial and ethnic disparities; racial disparity; research to practice; satisfaction; social health determinants; standard care; successful intervention; underserved community; uptake

SUMMARY Palliative care can reduce physical and psychological symptoms, improve quality of life, and ensure goal- concordant care at the end-of-life for patients with advanced cancer. There are persistent and worsening disparities in end-of-life outcomes for African American patients which are confounded by the lower likelihood of this population to access and receive palliative care. The basis for these disparities are multi-factorial, and at the end of life, barriers include personal or cultural values in conflict with hospice philosophy, a lack of awareness of hospice services, concern about burdening family, economic factors, and/or mistrust of the healthcare system. The addition of individuals to the care team with a nuanced skillset focused on addressing such barriers to care is a promising approach to enhance palliative care uptake. Community Health Workers (CHWs) are non-clinician, culturally competent public health workers whose role is to promote access to services, provide health education, support care delivery, and promote advocacy in underserved populations. CHWs supplement care for patients with advanced chronic diseases, including HIV/AIDS, tuberculosis, and cancer, and their impact on improving care in these settings is well-established. We developed an integrated CHW model – the Dissemination and Implementation of a Community Health Worker Intervention for Disparities in Palliative Care (DECIDE PC) – that utilizes CHWs as care team members to augment palliative care outcomes for underserved patients with advanced-stage illnesses. In DECIDE PC, CHWs are trained to provide advocacy, support, motivation, empowerment, and education regarding palliative and end-of-life care to patients and their caregivers. Our preliminary experience suggests that CHWs can improve palliative care outcomes and improve patient and caregiver satisfaction with care. Our long-term goal is to reduce disparities in palliative care for African Americans with advanced cancer. Integration of CHWs as members of the healthcare team may be an effective means to improve access to and enhance the uptake of palliative care in this population. To explore this, we will conduct a randomized effectiveness-implementation pragmatic trial at four diverse cancer centers to 1. compare the effectiveness of the DECIDE PC intervention versus standard care in improving palliative care outcomes, including quality of life, receipt of quality communication, advance care planning documentation/discussion, and hospice use, and 2. evaluate contextual factors that influence the effectiveness, fidelity, and adoption of the DECIDE PC intervention. We anticipate this work will establish the effectiveness of a CHW-based palliative care intervention in a priority population and generate generalizable knowledge to guide the development and implementation of interventions to increase the use of palliative care services in underserved populations.

概括 姑息治疗可以减轻身体和心理症状，提高生活质量，并确保目标- 晚期癌症患者临终时的协调护理。存在持续且恶化的情况 非裔美国患者的临终结果存在差异，这些差异因较低的可能性而令人困惑 该人群能够获得并接受姑息治疗。这些差异的基础是多方面的，并且 生命终结时，障碍包括与临终关怀理念相冲突的个人或文化价值观、缺乏对临终关怀的认识 临终关怀服务、对家庭负担的担忧、经济因素和/或对医疗保健系统的不信任。 护理团队中增加了具有细致入微技能的个人，专注于解决此类护理障碍 是提高姑息治疗采用率的一种有前途的方法。社区卫生工作者 (CHW) 是非临床医生， 具有文化能力的公共卫生工作者，其作用是促进获得服务、提供健康教育、 支持护理服务的提供，并促进对服务不足的人群的宣传。社区卫生工作者为患者提供补充护理 患有晚期慢性疾病，包括艾滋病毒/艾滋病、结核病和癌症，及其对改善病情的影响 这些环境中的护理是很完善的。我们开发了一个综合的 CHW 模型 – 传播和 针对姑息治疗差异实施社区卫生工作者干预措施 (DECIDE PC) – 利用社区卫生工作者作为护理团队成员，为服务不足的患者增强姑息治疗效果 晚期疾病。在 DECIDE PC 中，CHW 接受培训以提供宣传、支持、激励、 向患者及其护理人员提供有关姑息治疗和临终关怀的赋权和教育。我们的 初步经验表明，社区卫生工作者可以改善姑息治疗的结果，并改善患者和患者的健康状况。 护理人员对护理的满意度。 我们的长期目标是减少晚期癌症非裔美国人姑息治疗方面的差异。 将社区卫生工作者纳入医疗保健团队可能是改善获得医疗服务的有效途径 提高该人群对姑息治疗的接受度。为了探索这个问题，我们将进行一项随机 在四个不同的癌症中心进行有效性实施实用试验，以 1. 比较以下方案的有效性 DECIDE PC 干预与标准护理在改善姑息治疗结果（包括生活质量）方面的比较 收到高质量的沟通、预先护理计划文件/讨论和临终关怀服务，以及 2. 评估影响 DECIDE PC 干预的有效性、保真度和采用的背景因素。 我们预计这项工作将优先确定基于社区卫生工作者的姑息治疗干预措施的有效性 人口并产生通用知识来指导干预措施的制定和实施 增加在服务不足的人群中使用姑息治疗服务。