End-of-Life Cancer Care Redesign: Patient and Caregiver Experiences in a Lay Health Worker-Led Intervention.
Manali I Patel, David Moore, Tumaini R Coker
PMID 31046401WHAT IT FOUND
Veterans and caregivers described a lay health worker program as helping them build trust, think through end-of-life wishes, and talk openly with families and clinicians.
Caregivers reported feeling better prepared and seeing care match stated goals.
Key findings
01All surveyed intervention patients reported talking with the lay health worker at least 3 times, finding the intervention very helpful, and recommending it continue.
02Patient interviews produced themes of establishing trust, consistent and reliable guidance, and frequent timely discussions.
03Caregiver interviews after death produced themes of preparation for death, clear honest end-of-life discussions, and goal-concordant care.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only patients who were alive at the end of the 6-month intervention were surveyed or interviewed, so experiences of patients who died during the intervention were missing. Only intervention participants were asked about this program; usual care patients and caregivers were not included in these experience reports. Only 30 patients had an identified caregiver, and caregiver post-death interviews included 24 whose loved one died by follow-up. The intervention used one lay health worker at one VA facility, so it is unclear whether experiences reflect that person or setting. The findings are self-reported experiences and qualitative themes, not evidence that the intervention improved care or outcomes.
Declared interests
Funded by the VA Office of Patient-Centered Care. The authors declared no potential conflicts of interest.
The easy way to misread this
Do not read this as proof that a lay health worker program improves end-of-life care or can be replicated in other clinics. It reports experiences from one site with one lay health worker, and it did not include patients who died during the intervention period.