Apoyo con Carino: A Pilot Randomized Controlled Trial of a Patient Navigator Intervention to Improve Palliative Care Outcomes for Latinos With Serious Illness
Apoyo con Carino: A Pilot Randomized Controlled Trial of a Patient Navigator Intervention to Improve Palliative Care Outcomes for Latinos With Serious Illness
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DOI：
10.1016/j.jpainsymman.2014.08.011
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发表时间：
2015-04-01
影响因子：
4.7
通讯作者：
Kutner, Jean S.
中科院分区：
文献类型：
--
作者：
Fischer, Stacy M.;Cervantes, Lilia;Kutner, Jean S.
上下文与非拉丁裔相比，拉丁裔在生命结束时经历了显着的健康差异。确定患者导航干预的可行性，以改善拉丁美洲成年人严重疾病的姑息治疗结果。这是一项初步随机对照试验，包括64名患有生命限制性疾病的拉丁美洲成年人，随机分为干预组或对照组。所有参与者都收到了一包语言匹配的姑息治疗材料。此外，干预参与者接受了双语，双文化患者导航员的五次家访。访问的重点是通过教育、激活和文化定制的信息传递来解决姑息治疗的障碍。结果包括可行性和提前护理计划率，病历中疼痛管理讨论的记录，以及临终关怀的利用率。在随机分配至干预组的32例患者中，81%的患者至少使用患者导航器进行了一次家庭访视（范围1-5）。总体而言，干预组的提前护理计划更高（47% [n = 15] vs. 25% [n = 8]，P = 0.06），79%的干预参与者讨论了病历中记录的疼痛管理，而对照组患者的这一比例为54%（P = 0.05）。两组（n = 18例死亡）的临终关怀登记相似（n = 7例干预组vs. n = 6例对照组）;干预组的住院时间为36.4 +/- 51.6天，对照组为19.7 +/- 33.6天（P = 0.39）。一个文化定制的患者导航干预是可行的，并建议改善姑息治疗的结果，为拉丁美洲人面临先进的医疗疾病，证明了一个充分的动力随机对照试验。(C)2015年美国临终关怀和姑息医学学会。爱思唯尔公司出版All rights reserved.
Context. Latinos experience significant health disparities at the end of life compared with non-Latinos.Objectives. To determine the feasibility of a patient navigator intervention to improve palliative care outcomes for Latino adults with serious illness.Methods. This was a pilot randomized controlled trial that included 64 Latino adults with life-limiting illness randomized to an intervention or a control group. All participants received a packet of linguistically matched materials on palliative care. In addition, intervention participants received up to five home visits from the bilingual, bicultural patient navigator. Visits focused on addressing barriers to palliative care through education, activation, and culturally tailored messaging. Outcomes included feasibility and advance care planning rates, documentation of pain management discussions in the medical record, and hospice utilization.Results. Of the 32 patients randomized to the intervention arm, 81% had at least one home visit (range 1-5) with the patient navigator. Overall, advance care planning was higher in the intervention group (47% [n = 15] vs. 25% [n = 8], P = 0.06), and 79% of intervention participants had a discussion about pain management documented in their medical record vs. 54% of control patients (P = 0.05). Hospice enrollment between the two groups (n = 18 decedents) was similar (n = 7 intervention vs. n = 6 control); length of stay in the intervention group was 36.4 +/- 51.6 vs. 19.7 +/- 33.6 days for control patients (P = 0.39).Conclusion. A culturally tailored patient navigator intervention was feasible and suggests improved palliative care outcomes for Latinos facing advanced medical illness, justifying a fully powered randomized controlled trial. (C) 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.