Kubi Boateng, Enumah Zachary O, Lee Kimberley T, Freund Karen M, Smith Thomas J, Cooper Lisa A, Owczarzak Jill T, Johnston Fabian M
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Pain Symptom Manage. 2020 Jul;60(1):10-19. doi: 10.1016/j.jpainsymman.2020.02.009. Epub 2020 Feb 22.
Opportunities for the use of palliative care services are missed in African American (AA) communities, despite Level I evidence demonstrating their benefits.
Single-institution and stakeholder-engaged study to design an intervention to increase palliative care use in AA communities.
Two-phased qualitative research design guided by the Behavior Change Wheel and Theoretical Domains Framework models. In Phase 1, focus group sessions were conducted to identify barriers and facilitators of palliative care use and the viability of community health workers (CHWs) as a solution. After applying the Behavior Change Wheel and Theoretical Domains Framework to data gathered from Phase 1, Phase 2 consisted of a stakeholder meeting to select intervention content and prioritize modes of delivery.
A total of 15 stakeholders participated in our study. Target behaviors identified were for patients to gain knowledge about benefits of palliative care, physicians to begin palliative care discussions earlier in treatment, and to improve patient-physician interpersonal communication. The intervention was designed to improve patient capability, physician capability, patient motivation, physician motivation, and increase patient opportunities to use palliative care services. Strategies to change patient and physician behaviors were all facilitated by CHWs and included creation and dissemination of brochures about palliative care to patients, empowerment and activation of patients to initiate goals-of-care discussions, outreach to community churches, and expanding patient social support.
Use of a theory-based approach to facilitate the implementation of a multi-component strategy provided a comprehensive means of identifying relevant barriers and enablers of CHWs as an agent to increase palliative care use in AA communities.
尽管有一级证据表明姑息治疗服务有益，但非裔美国人社区仍错失了使用这些服务的机会。
开展单机构且有利益相关者参与的研究，以设计一项干预措施，增加非裔美国人社区对姑息治疗的使用。
采用由行为改变轮和理论领域框架模型指导的两阶段定性研究设计。在第一阶段，进行焦点小组会议，以确定姑息治疗使用的障碍和促进因素，以及社区卫生工作者作为一种解决方案的可行性。在将行为改变轮和理论领域框架应用于从第一阶段收集的数据后，第二阶段包括一次利益相关者会议，以选择干预内容并确定交付方式的优先级。
共有15名利益相关者参与了我们的研究。确定的目标行为包括让患者了解姑息治疗的益处，医生在治疗早期开始进行姑息治疗讨论，以及改善医患人际沟通。该干预措施旨在提高患者能力、医生能力、患者动机、医生动机，并增加患者使用姑息治疗服务的机会。改变患者和医生行为的策略均由社区卫生工作者推动，包括为患者创建和分发有关姑息治疗的宣传册，赋予患者权力并促使其启动治疗目标讨论，拓展社区教堂，以及扩大患者的社会支持。
采用基于理论的方法来促进多组分策略的实施，提供了一种全面的手段，以识别社区卫生工作者作为增加非裔美国人社区姑息治疗使用的推动者的相关障碍和促成因素。
