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- Title
Patient Navigator Intervention to Improve Palliative Care Outcomes for Hispanic Patients With Serious Noncancer Illness: A Randomized Clinical Trial.
- Authors
Fischer, Stacy M.; Min, Sung-Joon; Kline, Danielle M.; Lester, Kathleen; Gozansky, Wendolyn; Schifeling, Christopher; Himberger, John; Lopez, Joseph; Fink, Regina M.
- Abstract
This randomized clinical trial aims to determine the effectiveness of a lay patient navigator intervention in improving palliative care outcomes among Hispanic patients. Key Points: Question: Can a bicultural, bilingual lay patient navigator intervention improve palliative care outcomes for Hispanic patients experiencing serious noncancer illness? Findings: In this randomized clinical trial of 209 Hispanic adults with serious noncancer illness, patients who received patient navigator visits did not have improved quality of life at 3 months, the primary study outcome, compared with patients who simply received educational materials. Patients in the intervention group did have improved advance care planning and increased hospice utilization, but pain and symptom outcomes were not different between the groups. Meaning: A culturally tailored patient navigator intervention can help improve some palliative care–related outcomes for Hispanic patients with serious medical illness. Importance: Disparities persist across the trajectory of serious illness, including at the end of life. Patient navigation has been shown to reduce disparities and improve outcomes for underserved populations. Objective: To determine the effectiveness of a lay patient navigator intervention, Apoyo con Cariño, in improving palliative care outcomes among Hispanic patients. Design, Setting, and Participants: This was a multicenter randomized clinical trial that took place across academic, nonprofit, safety-net, and community health care systems in urban, rural, and mountain/frontier regions of Colorado from January 2017 to January 2021. Self-identifying Hispanic adults with serious noncancer medical illness and limited prognosis were recruited. Data were collected and analyzed from July 2022 to July 2023. Interventions: Participants randomized to the intervention group received 5 home visits from a bilingual, bicultural lay patient navigator; participants randomized to control received care as usual. Both groups received culturally tailored educational materials. Investigators/outcome accessors remained blinded to participant assignment. Main Outcomes and Measures: Change in score from baseline to 3 months on the Functional Assessment of Chronic Illness Therapy (FACIT) General quality of life (QOL) scale (primary outcome), Advance Care Planning (ACP) Engagement Survey, Brief Pain Inventory, Edmonton Symptom Assessment Scale, and FACIT Spiritual Well-Being subscale; at 6 months, advance directive (AD) documentation; and at 46 months or death, hospice utilization and length of stay, as well as aggressiveness of care at end of life. Results: Of 209 patients enrolled (mean [SD] age, 63.6 [14.3] years; 108 [51.7%] male), 105 patients were randomized to control and 104 patients to the intervention. There were no statistically significant differences in the change in mean (SD) QOL score between the intervention and control groups (5.0 [16.5] vs 4.3 [15.5]; P =.75). Participants in the intervention group, compared with the control group, had statistically significant greater increases in mean (SD) ACP engagement (0.8 [1.3] vs 0.1 [1.4]; P <.001) and were more likely to have a documented AD (62 of 104 [59.6%] vs 28 of 105 [26.9%]; P <.001). There were no statistically significant differences in mean (SD) change in pain intensity score (0-10) between patients in the intervention group compared with control (−0.4 [2.6] vs −0.5 [2.8]; P =.79), nor pain interference (−0.2 [3.7] vs −0.4 [3.7]; P =.71). Patients receiving the intervention were more likely to be referred to hospice compared with patients receiving control (19 of 43 patients [44.2%] vs 7 of 33 patients [21.2%]; P =.04) and less likely to receive aggressive care at end of life (27 of 42 patients [64.3%] vs 28 of 33 patients [84.8%]; P =.046). Conclusion and Relevance: In this randomized clinical trial, a culturally tailored patient navigator intervention did not improve QOL for patients. However, the intervention did increase ACP engagement, AD documentation, and hospice utilization in Hispanic persons with serious medical illness. Trial Registration: ClinicalTrials.gov Identifier: NCT03181750
- Publication
JAMA Internal Medicine, 2024, Vol 184, Issue 4, p384
- ISSN
2168-6106
- Publication type
Article
- DOI
10.1001/jamainternmed.2023.8145