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: 10686013
• 负责人: Fabian M Johnston
• 金额: --
• 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 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10686013
• 关键词: Address; Administrator; Adoption; Advance Care Planning; Advanced Malignant Neoplasm; Advocacy; Advocate; African American; African American population; American Society of Clinical Oncology; Awareness; Cancer Center; Caregivers; Caring; Chronic Disease; Communication; Communities; Community Health Aides; Community Healthcare; Complement; Conflict (Psychology); Consolidated Framework for Implementation Research; Development; Disease; Disparity; Dissemination and Implementation; Documentation; Economic Factors; Education; Effectiveness; Enrollment; Ensure; Evaluation; Evidence based practice; Family; Focus Groups; Funding; Goals; HIV/AIDS; Health; Health Services Accessibility; Health education; Healthcare; Healthcare Systems; Home; 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; Persons; Philosophy; Physicians; Pilot Projects; Population; 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; cancer care; care delivery; care outcomes; care systems; compare effectiveness; contextual factors; cultural competence; cultural values; design; disparity reduction; effectiveness-implementation randomized trial; empowerment; end of life; end of life care; ethnic disparity; evidence base; experience; family burden; health care delivery; health care disparity; high risk; hospice environment; implementation barriers; implementation evaluation; implementation facilitation; implementation intervention; implementation/effectiveness; improved; informant; intervention refinement; member; palliative; physical symptom; pragmatic trial; process evaluation; psychological symptom; racial disparity; research to practice; satisfaction; skills; 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.

总结

项目成果

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.

• DOI: 10.1186/s12904-023-01250-0
• 发表时间: 2023-09-18
• 期刊: BMC PALLIATIVE CARE
• 影响因子: 3.1
• 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.
• 通讯作者: Johnston, Fabian M.

Palliative Care Curriculum and Training Plan for community health workers.

社区卫生工作者姑息治疗课程和培训计划。

• DOI: 10.1136/spcare-2023-004527
• 发表时间: 2023
• 期刊: BMJ supportive & palliative care
• 影响因子: 2.7
• 作者: Monton,Olivia;Abou-Zamzam,Aida;Fuller,Shannon;Barnes-Malone,Tracy;Siddiqi,Amn;Woods,Alison;Patton,Jae;Ibe,ChidinmaA;Johnston,FabianM
• 通讯作者: Johnston,FabianM