Division of Oncology, Stanford University School of Medicine, 1070 Arastradero, Palo Alto, CA, 94305, USA.
Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
J Community Health. 2019 Oct;44(5):912-920. doi: 10.1007/s10900-019-00632-x.
Community-engaged adaptations of evidence-based interventions are needed to improve cancer care delivery for low-income and minority populations with cancer. The objective of this study was to adapt an intervention to improve end-of-life cancer care delivery using a community-partnered approach. We used a two-step formative research process to adapt the evidence-based lay health workers educate engage and encourage patients to share (LEAPS) cancer care intervention. The first step involved obtaining a series of adaptations through focus groups with 15 patients, 12 caregivers, and 6 leaders and staff of the Unite Here Health (UHH) payer organization, and 12 primary care and oncology care providers. Focus group discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. The second step involved finalization of adaptations from a community advisory board comprised of 4 patients, 2 caregivers, 4 oncology providers, 2 lay health workers and 4 UHH healthcare payer staff and executive leaders. Using this community-engaged approach, stakeholders identified critical barriers and solutions to intervention delivery which included: (1) expanding the intervention to ensure patient recruitment; (2) including caregivers; (3) regular communication between UHH staff, primary care and oncology providers; and (4) selecting outcomes that reflect patient-reported quality of life. This systematic and community-partnered approach to adapt an end-of-life cancer care intervention strengthened this existing intervention to promote the needs and preferences of patients, caregivers, providers, and healthcare payer leaders. This approach can be used to address cancer care delivery for low-income and minority patients with cancer.
需要采用社区参与式的循证干预措施来改善癌症护理服务，以满足低收入和少数族裔癌症患者的需求。本研究旨在采用社区伙伴合作的方法来调整一项干预措施，以改善临终癌症护理服务。我们使用两步形成性研究过程来调整循证的基层卫生工作者教育、参与和鼓励患者分享（LEAPS）癌症护理干预措施。第一步涉及通过与 15 名患者、12 名护理人员以及 6 名 Unite Here Health（UHH）支付方组织的领导和工作人员、12 名初级保健和肿瘤护理提供者进行焦点小组讨论，获得一系列调整措施。将焦点小组讨论录音、转录并使用定性分析的恒定性比较方法进行分析。第二步涉及由一个由 4 名患者、2 名护理人员、4 名肿瘤学提供者、2 名基层卫生工作者和 4 名 UHH 医疗支付方工作人员和执行领导组成的社区咨询委员会最终确定调整措施。通过这种社区参与式方法，利益相关者确定了干预措施实施的关键障碍和解决方案，包括：（1）扩大干预范围以确保患者招募；（2）包括护理人员；（3）UHH 工作人员、初级保健和肿瘤学提供者之间的定期沟通；（4）选择反映患者报告的生活质量的结果。这种对临终癌症护理干预措施进行系统和社区合作式调整的方法加强了现有的干预措施，以促进患者、护理人员、提供者和医疗支付方领导者的需求和偏好。这种方法可用于解决低收入和少数族裔癌症患者的癌症护理服务问题。
