Clarifying Values and Preferences for Care Near the End of Life: The Role of a New Lay Workforce

被引:20
作者
Litzelman, Debra K. [1 ,2 ]
Inui, Thomas S. [1 ,2 ]
Schmitt-Wendholt, Kathleen M. [1 ]
Perkins, Anthony [3 ]
Griffin, Wilma J. [4 ]
Cottingham, Ann H. [2 ]
Ivy, Steven S. [4 ,5 ]
机构
[1] Regenstrief Inst Inc, 1101 West Tenth St, Indianapolis, IN 46202 USA
[2] IU Sch Med, Dept Med, Indianapolis, IN 46202 USA
[3] Indiana Univ, Indiana Clin & Translat Sci Inst, Ctr Healthcare Innovat & Implementat Sci, Indianapolis, IN 46204 USA
[4] Indiana Univ Hlth, Indianapolis, IN USA
[5] Charles Warren Fairbanks Ctr Med Eth, Indianapolis, IN USA
关键词
End-of-life conversations; Clarifying end-of-life goals; Community health worker; RANDOMIZED CONTROLLED-TRIAL; ADVANCE DIRECTIVES; ELDERLY-PATIENTS; CANCER-PATIENTS; DEMENTIA CARE; LUNG-CANCER; FAMILIES; SPIRITUALITY; MULTICENTER; DISCUSSIONS;
D O I
10.1007/s10900-017-0336-5
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Community health workers (CHWs) can engage elderly persons in advance care planning (ACP) conversations. We report how trained CHWs used Go Wish cards (GW (R) cards) to identify patients' highest priority preferences and evaluated whether engaging in ACP conversations was associated with subsequent health care utilization. A one-year long, pre-post longitudinal design was used to evaluate our educational intervention using mixed-methods. 392 patients (mean of 73.3 years, 82% women, 48% African American, 43% Caucasian) enrolled in the Aging Brain Care (ABC) program and participated in ACP discussions with CHWs. We expanded the role of the ABC's CHW, who work directly with individuals and caregivers during home visits to monitor bio-psycho-social needs, to include ACP conversations. The CHWs received ACP training, practice with tools such as GW (R) cards, and support from an electronic health record (EHR) clinical decision support tool. Quantitative measures of patients' ACP preferences and health care utilization were abstracted from the EHR. Qualitative data about patients' perceptions of CHWs in facilitating ACP discussions was obtained through semi-structured interviews. Eighty-six patients' data indicated that they had engaged in a preferences-for-care process using GW (R) cards. The top-three card choices by patients was attending to spirituality and religious concerns, preparing for end of life, and maintaining personal wholeness. CHWs were able to effectively engage in ACP conversations with patients and GW (R) cards were a positive way to stimulate discussion of issues previously undiscussed.
引用
收藏
页码:926 / 934
页数:9
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