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Implementation and Impact of Patient Lay Navigator-Led Advance Care Planning Conversations
Gabrielle B Rocque1, J Nicholas Dionne-Odom2, Chao-Hui Sylvia Huang3
1Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Journal of Pain and Symptom Management
|January 8, 2017
Summary
Lay navigators can implement advance care planning (ACP) effectively in cancer centers. Navigator-led ACP may reduce end-of-life (EOL) healthcare utilization, improving patient care alignment.
Area of Science:
- Oncology
- Palliative Care
- Healthcare Implementation Science
Background:
- Advance care planning (ACP) is crucial for aligning patient end-of-life (EOL) treatment preferences with care received.
- Implementing ACP programs effectively is essential for improving patient outcomes.
Purpose of the Study:
- To evaluate the feasibility and impact of a lay navigator-led ACP program in 12 cancer centers.
- To assess navigator self-efficacy, patient resource utilization, and barriers/facilitators to ACP implementation.
Main Methods:
- A convergent, parallel mixed-methods design was employed.
- Data included electronic navigation records, navigator surveys (n=45), patient claims data (n=820), and navigator interviews (n=26).
- Outcomes measured were ACP conversation completion, navigator self-efficacy, EOL resource utilization, and implementation factors.
Main Results:
- Navigators approached 18% of patients, with higher engagement among African American patients.
- Navigator self-efficacy significantly increased post-training (5.6/10 to 7.5/10).
- Patients engaged in ACP had fewer hospitalizations in their final 30 days compared to those who declined (46% vs. 56%).
Conclusions:
- Navigator-led ACP programs are feasible in cancer center settings.
- This model may be associated with reduced end-of-life healthcare resource utilization.
- Physician buy-in and patient readiness are key facilitators, while logistical issues and discomfort pose barriers.
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