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)

基本信息

批准号：
10457912
负责人：
Fabian M Johnston
金额：
$ 57.04万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
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/10457912
关键词：
AIDS/HIV problem 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 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 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 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 evaluation implementation facilitation implementation intervention improved informant member palliative physical symptom pragmatic implementation pragmatic trial process evaluation psychological symptom racial and ethnic disparities racial disparity research to practice satisfaction social health determinants standard care successful intervention underserved community uptake

项目摘要

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，改善生活质量并确保目标 - 晚期癌症患者在终止生命终止的一致护理。有持久而令人担忧的非洲裔美国患者的临终结局差异，这与较低的可能性混淆该人群获得和接受姑息治疗。这些差异的基础是多因素，在生命的尽头，障碍包括与临终关怀哲学冲突的个人或文化价值观，缺乏意识临终关怀服务，对燃烧家庭的关注，经济因素和/或医疗保健系统的不信任。以细微的技能集中在护理团队中增加个人，重点是解决此类护理障碍是一种增强姑息治疗吸收的有前途的方法。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，他们的作用是促进服务，提供健康教育，支持护理交付，并促进服务不足的人群的倡导。 CHWS补充剂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，及其对改善的影响在这些环境中的护理已经建立了良好的。我们开发了一个集成的CHW模型 - 传播和实施社区卫生工作者干预姑息治疗方面的差异（决定PC） - 利用CHW作为护理团队成员来增加服务不足的患者的姑息治疗结果晚期疾病。在决定PC中，对CHW进行了培训以提供倡导，支持，动力，授权和有关姑息治疗的教育以及对患者及其护理人员的教育。我们的初步经验表明，CHW可以改善姑息治疗结果并改善患者，护理人员对护理的满意。我们的长期目标是减少患有晚期癌症的非洲裔美国人的姑息治疗差异。 CHW作为医疗团队成员的整合可能是提高进入和访问权限的有效手段增强该人群的姑息治疗的吸收。为了探讨这一点，我们将进行随机在四个潜水癌症中心的有效性实践实用试验至1。决定PC干预与标准护理，以改善姑息治疗结果，包括生活质量，收到质量沟通，预先护理计划文档/讨论以及临终关怀的使用以及2。评估影响PC干预措施的有效性，忠诚度和采用的上下文因素。我们预计这项工作将确定基于CHW的姑息治疗干预措施的有效性人口并产生可推广的知识，以指导干预措施的发展和实施增加在服务不足的人群中使用姑息治疗服务。