Division of Oncology, 6429Stanford University School of Medicine, Stanford, CA, USA.
Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
Am J Hosp Palliat Care. 2021 Oct;38(10):1202-1211. doi: 10.1177/1049909120977841. Epub 2020 Dec 3.
Advance care planning and symptom screening among patients with cancer require team-based approaches to ensure that these services are equitably and appropriately delivered. In several organizations across the United States, we trained and employed lay health workers (LHWs) to assist with delivering these services for patients with cancer. The aim of this study was to understand LHWs' views on delivering these services.
We conducted semi-structured interviews with 22 LHWs in 6 US-based clinical cancer care settings in 4 large cities. We recorded, transcribed, and analyzed interviews using the constant comparative method of qualitative analysis.
Participants noted the importance of their role in assisting with the delivery of advance care planning (ACP) and symptom screening services. Participants noted the importance of developing relationships with patients to engage openly in ACP and symptom screening discussions. Participants reported that ongoing training provided skills and empowered them to discuss sensitive issues with patients and their caregivers. Participants described challenges in their roles including communication with oncology providers and their own emotional well-being. Participants identified solutions to these challenges including formal opportunities for introduction with oncology clinicians and staff and grievance sessions with LHWs and other team members.
LHWs from several organizations endorsed the importance of their roles in ensuring the delivery of ACP and proactive symptom screening. LHWs noted challenges and specific solutions to improve their effectiveness in delivering these important services to patients after their diagnosis of cancer.
在癌症患者中进行预先护理计划和症状筛查需要团队合作的方法，以确保这些服务能够公平和适当地提供。在美国的几个组织中，我们培训并雇用了非专业卫生工作者（LHWs）来协助为癌症患者提供这些服务。本研究的目的是了解 LHWs 提供这些服务的观点。
我们在 4 个大城市的 6 个美国临床癌症护理环境中对 22 名 LHW 进行了半结构化访谈。我们使用定性分析的恒定比较方法记录、转录和分析访谈。
参与者注意到他们在协助提供预先护理计划（ACP）和症状筛查服务方面的角色的重要性。参与者注意到与患者建立关系的重要性，以便与他们公开地进行 ACP 和症状筛查讨论。参与者报告说，持续的培训提供了技能，并使他们有能力与患者及其护理人员讨论敏感问题。参与者描述了他们角色中的挑战，包括与肿瘤医生的沟通和他们自己的情绪健康。参与者确定了解决这些挑战的方法，包括与肿瘤临床医生和工作人员正式介绍的机会，以及 LHWs 和其他团队成员的申诉会议。
来自几个组织的 LHWs 认可他们在确保提供 ACP 和主动症状筛查方面的角色的重要性。LHWs 注意到了挑战，并提出了具体的解决方案，以提高他们在为癌症诊断后的患者提供这些重要服务的效果。
