1 Department of Medicine, Veterans Affairs Eastern Colorado Health Care System , Denver, Colorado.
2 Department of Medicine, University of Colorado School of Medicine , Anschutz Medical Campus, Aurora, Colorado.
J Palliat Med. 2018 Jul;21(7):1011-1016. doi: 10.1089/jpm.2017.0424. Epub 2018 Feb 20.
Patients with cancer could benefit from early primary (i.e., basic) palliative care. Scalable models of care delivery are needed.
Examine the feasibility of a stepped peer navigator and social work intervention developed to improve palliative care outcomes.
Single-arm prospective clinical trial. The peer navigator educated patients to advocate for pain and symptom management with their healthcare providers, motivated patients to pursue advance care planning, and discussed the role of hospice. The social worker saw patients with persistent psychosocial distress.
SETTING/SUBJECTS: Patients with advanced cancer at a VA Medical Center not currently in palliative care or hospice whose oncologist would not be surprised if the patient died in the subsequent year.
Participation and retention rates, patient-reported symptoms and quality of life, advance directive documentation, patient satisfaction survey, and semistructured interviews.
The participation rate was 38% (17/45), and 35% (7/17) completed final survey measures. Patients had stage IV (81%) and primarily genitourinary (47%) and lung (24%) malignancies. Median Eastern Cooperative Oncology Group performance status was 0. Patient-reported surveys indicated low distress (mean scores: Functional Assessment of Cancer Therapy-General, 75.3 [standard deviation {SD} 17.6]; Edmonton Symptom Assessment Scale symptom scores ranged from 1.6 to 3.8; Patient Health Questionnaire-9, 5.7 [SD 5.2]; and Generalized Anxiety Disorder-7, 2.8 [SD 4.1]). Of those who had not completed advance directives at baseline (n = 11, 65%), five completed them by the end of study (5/11, 45%). Patients who completed satisfaction surveys (n = 7) and interviews (n = 4) provided mixed reviews of the intervention.
At a single site, a stepped peer navigator and social work palliative care study had several challenges to feasibility, including low patient-reported distress and loss to follow-up.
癌症患者可能受益于早期初级（即基本）姑息治疗。需要可扩展的护理模式。
研究一种阶梯式同伴导航员和社会工作干预措施，以改善姑息治疗结局。
单臂前瞻性临床试验。同伴导航员教育患者向医疗保健提供者主张疼痛和症状管理，激励患者进行预先护理计划，并讨论临终关怀的角色。社会工作者治疗有持续心理困扰的患者。
地点/受试者：退伍军人事务医疗中心的晚期癌症患者，目前未接受姑息治疗或临终关怀，如果患者在随后一年死亡，他们的肿瘤医生不会感到惊讶。
参与率和保留率、患者报告的症状和生活质量、预先指示文件、患者满意度调查和半结构化访谈。
参与率为 38%（17/45），35%（7/17）完成了最终调查措施。患者患有第四期（81%）疾病，主要为泌尿生殖系统（47%）和肺部（24%）恶性肿瘤。东部合作肿瘤学组的平均表现状态为 0. 患者报告的调查表明低压力（平均得分：癌症治疗功能评估一般，75.3[标准差 17.6]；爱丁堡症状评估量表症状评分范围为 1.6 至 3.8；患者健康问卷-9，5.7[标准差 5.2]；广泛性焦虑障碍-7，2.8[标准差 4.1]）。在基线时没有完成预先指示的 11 名患者中（65%），有 5 名患者在研究结束时完成了预先指示（5/11，45%）。完成满意度调查（n=7）和访谈（n=4）的患者对干预措施有不同的评价。
在一个单一的地点，一个阶梯式同伴导航员和社会工作姑息治疗研究有几个可行性的挑战，包括低患者报告的压力和失访。
