Implementation and Impact of Patient Lay Navigator-Led Advance Care Planning Conversations.

Academic Article

Abstract

  • CONTEXT: Advance care planning (ACP) improves alignment between patient preferences for life-sustaining treatment and care received at end of life (EOL). OBJECTIVES: To evaluate implementation of lay navigator-led ACP. METHODS: A convergent, parallel mixed-methods design was used to evaluate implementation of navigator-led ACP across 12 cancer centers. Data collection included 1) electronic navigation records, 2) navigator surveys (n = 45), 3) claims-based patient outcomes (n = 820), and 4) semistructured navigator interviews (n = 26). Outcomes of interest included 1) the number of ACP conversations completed, 2) navigator self-efficacy, 3) patient resource utilization, hospice use, and chemotherapy at EOL, and 4) navigator-perceived barriers and facilitators to ACP. RESULTS: From June 1, 2014 to December 31, 2015, 50 navigators completed Respecting Choices® First Steps ACP Facilitator training. Navigators approached 18% of patients (1319/8704); 481 completed; 472 in process; 366 declined. Navigators were more likely to approach African American patients than Caucasian patients (20% vs. 14%, P < 0.001). Significant increases in ACP self-efficacy were observed after training. The mean score for feeling prepared to conduct ACP conversations increased from 5.6/10 to 7.5/10 (P < 0.001). In comparison with patients declining ACP participation (n = 171), decedents in their final 30 days of life who engaged in ACP (n = 437) had fewer hospitalizations (46% vs. 56%, P = 0.02). Key facilitators of successful implementation included physician buy-in, patient readiness, and prior ACP experience; barriers included space limitations, identifying the "right" time to start conversations, and personal discomfort discussing EOL. CONCLUSION: A navigator-led ACP program was feasible and may be associated with lower rates of resource utilization near EOL.
  • Keywords

  • Advance care planning, end of life, lay navigation, lay navigator, Advance Care Planning, Aged, Antineoplastic Agents, Communication, Education, Medical, Feasibility Studies, Female, Follow-Up Studies, Health Personnel, Humans, Interviews as Topic, Male, Neoplasms, Patient Navigation, Patient Preference, Qualitative Research, Self Efficacy, Surveys and Questionnaires, Terminal Care
  • Digital Object Identifier (doi)

    Author List

  • Rocque GB; Dionne-Odom JN; Sylvia Huang C-H; Niranjan SJ; Williams CP; Jackson BE; Halilova KI; Kenzik KM; Bevis KS; Wallace AS
  • Start Page

  • 682
  • End Page

  • 692
  • Volume

  • 53
  • Issue

  • 4