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

Gabrielle B. Rocque, J. Nicholas Dionne-Odom, Chao Hui Sylvia Huang, Soumya J. Niranjan, Courtney P. Williams, Bradford E. Jackson, Karina I. Halilova, Kelly M. Kenzik, Kerri S. Bevis, Audrey S. Wallace, Nedra Lisovicz, Richard A. Taylor, Maria Pisu, Edward E. Partridge, Thomas W. Butler, Linda A. Briggs, Elizabeth A. Kvale, Lee Jackson, Zoe Scott, Guilherme Cantuaria & 41 others Debbie Bickes, Tina Berry, George Reiss, Hang Mai, Ming Chang, Louiz Gomez, Rhonda Meeker, James Clarkson, Maggie Clarkson, Steven Stokes, Tina Newman, Mary Sheffield, Ellen Spremulli, Wendy Watson, Tom Payne, Hanna Bright, Stacey Holman, Thomas Butler, Cathy Tinnea, Fred Schnell, Cyndi Pyle, Gabrielle B. Rocque, Richard Taylor, Aras Acemgil, Xuelin Li, Kelly M. Kenzik, Bradford E. Jackson, Karina I. Halilova, Maria Pisu, Wendy Demark-Wahnefried, Karen Meneses, Yufeng Li, Michelle Martin, Carol Chambless, Nedra Lisovicz, Valeria Pacheco-Rubi, Terri L. Salter, Warren Smedley, Mona Fouad, Elizabeth A. Kvale, Edward E. Partridge

Research output: Contribution to journalArticle

23 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)682-692
Number of pages11
JournalJournal of Pain and Symptom Management
Volume53
Issue number4
DOIs
StatePublished - Apr 1 2017

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Patient Navigation
Advance Care Planning
Self Efficacy
Hospices
Patient Preference

All Science Journal Classification (ASJC) codes

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Rocque, G. B., Dionne-Odom, J. N., Sylvia Huang, C. H., Niranjan, S. J., Williams, C. P., Jackson, B. E., ... Partridge, E. E. (2017). Implementation and Impact of Patient Lay Navigator-Led Advance Care Planning Conversations. Journal of Pain and Symptom Management, 53(4), 682-692. https://doi.org/10.1016/j.jpainsymman.2016.11.012

Implementation and Impact of Patient Lay Navigator-Led Advance Care Planning Conversations. / Rocque, Gabrielle B.; Dionne-Odom, J. Nicholas; Sylvia Huang, Chao Hui; Niranjan, Soumya J.; Williams, Courtney P.; Jackson, Bradford E.; Halilova, Karina I.; Kenzik, Kelly M.; Bevis, Kerri S.; Wallace, Audrey S.; Lisovicz, Nedra; Taylor, Richard A.; Pisu, Maria; Partridge, Edward E.; Butler, Thomas W.; Briggs, Linda A.; Kvale, Elizabeth A.; Jackson, Lee; Scott, Zoe; Cantuaria, Guilherme; Bickes, Debbie; Berry, Tina; Reiss, George; Mai, Hang; Chang, Ming; Gomez, Louiz; Meeker, Rhonda; Clarkson, James; Clarkson, Maggie; Stokes, Steven; Newman, Tina; Sheffield, Mary; Spremulli, Ellen; Watson, Wendy; Payne, Tom; Bright, Hanna; Holman, Stacey; Butler, Thomas; Tinnea, Cathy; Schnell, Fred; Pyle, Cyndi; Rocque, Gabrielle B.; Taylor, Richard; Acemgil, Aras; Li, Xuelin; Kenzik, Kelly M.; Jackson, Bradford E.; Halilova, Karina I.; Pisu, Maria; Demark-Wahnefried, Wendy; Meneses, Karen; Li, Yufeng; Martin, Michelle; Chambless, Carol; Lisovicz, Nedra; Pacheco-Rubi, Valeria; Salter, Terri L.; Smedley, Warren; Fouad, Mona; Kvale, Elizabeth A.; Partridge, Edward E.

In: Journal of Pain and Symptom Management, Vol. 53, No. 4, 01.04.2017, p. 682-692.

Research output: Contribution to journalArticle

Rocque, GB, Dionne-Odom, JN, Sylvia Huang, CH, Niranjan, SJ, Williams, CP, Jackson, BE, Halilova, KI, Kenzik, KM, Bevis, KS, Wallace, AS, Lisovicz, N, Taylor, RA, Pisu, M, Partridge, EE, Butler, TW, Briggs, LA, Kvale, EA, Jackson, L, Scott, Z, Cantuaria, G, Bickes, D, Berry, T, Reiss, G, Mai, H, Chang, M, Gomez, L, Meeker, R, Clarkson, J, Clarkson, M, Stokes, S, Newman, T, Sheffield, M, Spremulli, E, Watson, W, Payne, T, Bright, H, Holman, S, Butler, T, Tinnea, C, Schnell, F, Pyle, C, Rocque, GB, Taylor, R, Acemgil, A, Li, X, Kenzik, KM, Jackson, BE, Halilova, KI, Pisu, M, Demark-Wahnefried, W, Meneses, K, Li, Y, Martin, M, Chambless, C, Lisovicz, N, Pacheco-Rubi, V, Salter, TL, Smedley, W, Fouad, M, Kvale, EA & Partridge, EE 2017, 'Implementation and Impact of Patient Lay Navigator-Led Advance Care Planning Conversations', Journal of Pain and Symptom Management, vol. 53, no. 4, pp. 682-692. https://doi.org/10.1016/j.jpainsymman.2016.11.012
Rocque GB, Dionne-Odom JN, Sylvia Huang CH, Niranjan SJ, Williams CP, Jackson BE et al. Implementation and Impact of Patient Lay Navigator-Led Advance Care Planning Conversations. Journal of Pain and Symptom Management. 2017 Apr 1;53(4):682-692. https://doi.org/10.1016/j.jpainsymman.2016.11.012
Rocque, Gabrielle B. ; Dionne-Odom, J. Nicholas ; Sylvia Huang, Chao Hui ; Niranjan, Soumya J. ; Williams, Courtney P. ; Jackson, Bradford E. ; Halilova, Karina I. ; Kenzik, Kelly M. ; Bevis, Kerri S. ; Wallace, Audrey S. ; Lisovicz, Nedra ; Taylor, Richard A. ; Pisu, Maria ; Partridge, Edward E. ; Butler, Thomas W. ; Briggs, Linda A. ; Kvale, Elizabeth A. ; Jackson, Lee ; Scott, Zoe ; Cantuaria, Guilherme ; Bickes, Debbie ; Berry, Tina ; Reiss, George ; Mai, Hang ; Chang, Ming ; Gomez, Louiz ; Meeker, Rhonda ; Clarkson, James ; Clarkson, Maggie ; Stokes, Steven ; Newman, Tina ; Sheffield, Mary ; Spremulli, Ellen ; Watson, Wendy ; Payne, Tom ; Bright, Hanna ; Holman, Stacey ; Butler, Thomas ; Tinnea, Cathy ; Schnell, Fred ; Pyle, Cyndi ; Rocque, Gabrielle B. ; Taylor, Richard ; Acemgil, Aras ; Li, Xuelin ; Kenzik, Kelly M. ; Jackson, Bradford E. ; Halilova, Karina I. ; Pisu, Maria ; Demark-Wahnefried, Wendy ; Meneses, Karen ; Li, Yufeng ; Martin, Michelle ; Chambless, Carol ; Lisovicz, Nedra ; Pacheco-Rubi, Valeria ; Salter, Terri L. ; Smedley, Warren ; Fouad, Mona ; Kvale, Elizabeth A. ; Partridge, Edward E. / Implementation and Impact of Patient Lay Navigator-Led Advance Care Planning Conversations. In: Journal of Pain and Symptom Management. 2017 ; Vol. 53, No. 4. pp. 682-692.
@article{ca4664f108444cfc82e0cf671d9b85ae,
title = "Implementation and Impact of Patient Lay Navigator-Led Advance Care Planning Conversations",
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{\circledR} 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.",
author = "Rocque, {Gabrielle B.} and Dionne-Odom, {J. Nicholas} and {Sylvia Huang}, {Chao Hui} and Niranjan, {Soumya J.} and Williams, {Courtney P.} and Jackson, {Bradford E.} and Halilova, {Karina I.} and Kenzik, {Kelly M.} and Bevis, {Kerri S.} and Wallace, {Audrey S.} and Nedra Lisovicz and Taylor, {Richard A.} and Maria Pisu and Partridge, {Edward E.} and Butler, {Thomas W.} and Briggs, {Linda A.} and Kvale, {Elizabeth A.} and Lee Jackson and Zoe Scott and Guilherme Cantuaria and Debbie Bickes and Tina Berry and George Reiss and Hang Mai and Ming Chang and Louiz Gomez and Rhonda Meeker and James Clarkson and Maggie Clarkson and Steven Stokes and Tina Newman and Mary Sheffield and Ellen Spremulli and Wendy Watson and Tom Payne and Hanna Bright and Stacey Holman and Thomas Butler and Cathy Tinnea and Fred Schnell and Cyndi Pyle and Rocque, {Gabrielle B.} and Richard Taylor and Aras Acemgil and Xuelin Li and Kenzik, {Kelly M.} and Jackson, {Bradford E.} and Halilova, {Karina I.} and Maria Pisu and Wendy Demark-Wahnefried and Karen Meneses and Yufeng Li and Michelle Martin and Carol Chambless and Nedra Lisovicz and Valeria Pacheco-Rubi and Salter, {Terri L.} and Warren Smedley and Mona Fouad and Kvale, {Elizabeth A.} and Partridge, {Edward E.}",
year = "2017",
month = "4",
day = "1",
doi = "10.1016/j.jpainsymman.2016.11.012",
language = "English (US)",
volume = "53",
pages = "682--692",
journal = "Journal of Pain and Symptom Management",
issn = "0885-3924",
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TY - JOUR

T1 - Implementation and Impact of Patient Lay Navigator-Led Advance Care Planning Conversations

AU - Rocque, Gabrielle B.

AU - Dionne-Odom, J. Nicholas

AU - Sylvia Huang, Chao Hui

AU - Niranjan, Soumya J.

AU - Williams, Courtney P.

AU - Jackson, Bradford E.

AU - Halilova, Karina I.

AU - Kenzik, Kelly M.

AU - Bevis, Kerri S.

AU - Wallace, Audrey S.

AU - Lisovicz, Nedra

AU - Taylor, Richard A.

AU - Pisu, Maria

AU - Partridge, Edward E.

AU - Butler, Thomas W.

AU - Briggs, Linda A.

AU - Kvale, Elizabeth A.

AU - Jackson, Lee

AU - Scott, Zoe

AU - Cantuaria, Guilherme

AU - Bickes, Debbie

AU - Berry, Tina

AU - Reiss, George

AU - Mai, Hang

AU - Chang, Ming

AU - Gomez, Louiz

AU - Meeker, Rhonda

AU - Clarkson, James

AU - Clarkson, Maggie

AU - Stokes, Steven

AU - Newman, Tina

AU - Sheffield, Mary

AU - Spremulli, Ellen

AU - Watson, Wendy

AU - Payne, Tom

AU - Bright, Hanna

AU - Holman, Stacey

AU - Butler, Thomas

AU - Tinnea, Cathy

AU - Schnell, Fred

AU - Pyle, Cyndi

AU - Rocque, Gabrielle B.

AU - Taylor, Richard

AU - Acemgil, Aras

AU - Li, Xuelin

AU - Kenzik, Kelly M.

AU - Jackson, Bradford E.

AU - Halilova, Karina I.

AU - Pisu, Maria

AU - Demark-Wahnefried, Wendy

AU - Meneses, Karen

AU - Li, Yufeng

AU - Martin, Michelle

AU - Chambless, Carol

AU - Lisovicz, Nedra

AU - Pacheco-Rubi, Valeria

AU - Salter, Terri L.

AU - Smedley, Warren

AU - Fouad, Mona

AU - Kvale, Elizabeth A.

AU - Partridge, Edward E.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - 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.

AB - 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.

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