In adults with advanced-stage cancer, community health worker (CHW)-initiated advanced care planning (ACP) and symptom screening compared to usual cancer care alone, results from a randomized clinical trial showed that acute The risk of using early-stage medical care has been significantly reduced. Published in (NCT03154190) JAMA Oncology.

The CHW-led intervention reduced the risk of acute treatment by 62% (HR, 0.38; 95% CI, 0.19-0.76) within 6 months, and reduced the risk by 17% (odds ratio) [OR], 0.83; 95% CI, 0.69-0.98) compared with controls within 12 months. The intervention group had eight times the odds of an advance care plan (OR, 7.18; 95% CI, 2.85-18.13) and four times the odds of palliative care (OR, 4.46; 95% CI, 1.88-10.55). I understand. ), almost doubled the odds of hospice (OR, 1.83; 95% CI, 1.16-2.88) and improved mental and emotional health from baseline to 6 and 12 months after enrollment (OR, 1.82; 95% CI, 1.03-3.28; and OR, 2.20; 95% CI, 1.04-4.65, respectively) versus controls. Intervention participants were also 23.1% less likely to receive acute care in the month before death than those who received usual care only.

“In this study, we developed and implemented a high-touch, low-cost, technology-independent intervention that integrates CHW into cancer care immediately after initial or recurrent cancer diagnosis. It has been informed by patient, clinician, and payer stakeholders that it may be a more acceptable and effective approach to overcome previously identified structural barriers to delivery.” writes the researcher.

A randomized trial, conducted at the Virginia K. Croson Cancer Center in Fullerton, CA, examined the activity of two part-time (20 hours per week) CHWs in the intervention group. Of the 128 patients included in the analysis, randomization was 1:1 to either the intervention group or the usual care group (n = 64 each). The median patient age was 67 years (range, 19–89 years), and most patients were Caucasian (67.2%) and had private insurance (60.9%). Most patients had at least some degree of college education or a 2-year degree (32.8%), a 4-year college degree (14.8%), or more than 4 years of college (15.6%). At initial presentation, stage IV cancer was the most common (75.8%) and most (40.6%) recurred. The most common sites of malignancy were the gastrointestinal tract (38.2%), breast structures (18.8%), or gynecological organs (8.6%).

Two CHWs, a white ex-nurse and a bilingual Latino female, were recruited on the basis of their interpersonal skills and trained for the role using a curriculum developed by the principal investigator. Each offered a structured program to their assigned participants twice monthly for 6 months. Her one-on-one open-ended discussion between CHW and participants also took place.

In the first 6 months, in addition to reduced emergency care use and other factors, participants in the intervention group had a lower risk of emergency department (ED) use (15.6% vs. 31.3%), with a mean ED visit of 70. % less. (RR, 0.30; 95% CI, 0.20-0.47) than controls. Of note, there was a statistical difference between the odds of ED use (OR, 0.84; 95% CI, 0.70-1.00) or hospitalization (OR, 0.85; 95% CI, 0.71-1.02) between groups at 12 months. Although there was no significant difference in , researchers reported fewer mean events in both categories of patients receiving CHW-initiated interventions and standard care (RR, 0.45; 95% CI, 0.33–0.62, respectively). ; and RR, 0.50; 95% CI, 0.36–0.70).

Some of the benefits of CHW-led interventions persisted after the study ended. As expected, at 12-month follow-up, more participants had either an ED visit or hospitalization, and the difference between groups was smaller, but the intervention was not associated with these services. 6 months after the intervention ended, there was a 55% reduction in emergency department visits and a 50% reduction in hospitalizations,” the researchers wrote.

Future studies may include surveys of larger and more diverse groups of participants and longer follow-up periods, the researchers said. This trial he conducted in only one community clinic and had a small number of black participants, which limited generalization. Nonetheless, the results showed potentially strong benefits of CHW-directed interventions for adults with advanced stages of cancer.

reference

Patel MI, Kappan K, Durand M, Impact of Community Health Provider Interventions on Acute Care Use, Advance Care Planning, and Patient-Reported Outcomes in Adults With Advanced Stages of Other Cancers: A Randomized Clinical Trial. . JAMA Oncol. 2022;8(8):1139-1148.doi:10.1001/jamaoncol.2022.1997