Cancer, End-of-Life
Conditions
Keywords
end of life, quality of care, cancer care delivery
Brief summary
The purpose of the Team Based Advance Care Planning CAREPLAN program is to understand if a trained lay navigator who engages with patients with advanced stages of cancer can help patients in advance care planning, improve patient activation, satisfaction, quality of life, and the quality of end of life cancer care while also ensuring goal concordant cancer care at the end of life.
Detailed description
Stanford Cancer Institute plans to implement and evaluate several critical elements to be in alignment with the mission of the organization to provide high value care to their patients. The CAREPLAN (Coaches Activating, Reaching, and Engaging Patients in Their End of Life Care Plan) intervention is an innovative program aimed to strengthen provider-patient relationships and facilitate whole person care about matters important to patients diagnosed with advanced stages of cancer and important to patients' support network and family. The project is intended to help establish patients' Goals of Care Plan with appropriate documentation, develop, deploy, and evaluate a model of care for patients with cancer that is intended to improve clinical outcomes and their experiences with their cancer care. The intervention provides patients with lay navigators who assist them and their families in formulating and discussing their goals of care with their health care teams in hopes to engage in shared-decision making for goal concordant care. The goal of the project is to demonstrate that there is improved documentation of goals of care, patient experiences, patient activation, quality of life, and quality of care and communication and that the program helps to improve goal concordant care receipt at the end of life.
Interventions
BEHAVIORALLay Navigator Intervention
Patients randomized into the intervention will be assigned a lay health worker who will contact the patient to begin the intervention. The intervention includes: education on early advance care planning and documenting goals of care.
OTHERUsual Care
Usual care as provided by local oncologists
Sponsors
Stanford University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Intervention model description
As part of usual care, patients with cancer are assigned to services by a lay navigator and this will be the control group. For patients in the intervention, they will be assigned to the usual care lay navigator but will receive services by a lay navigator who is trained to engage patients in advance care planning.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All patients who receive care at Stanford Cancer Institute and have genitourinary cancers and have received greater than 2 prior courses of chemotherapy treatment
Exclusion criteria
* Patients without capacity to consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Goals of Care Documentation | 12 months after patient enrollment | Goals of Care documentation for each patient will be abstracted by electronic medical record chart review for each patient at 12 months after enrollment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Emergency Department Visit using chart abstraction | 12 months after patient enrollment | Emergency Department Use for each patient will be assessed by electronic health record abstraction from time of enrollment to 12 months after patient enrollment |
| Hospitalization Visit using chart abstraction | 12 months after patient enrollment | Hospitalization Visits for each patient will be assessed by electronic health record abstraction from time of enrollment to 12 months after patient enrollment |
| Palliative care using chart abstraction | 12 months after patient enrollment | Palliative care use for each patient will be assessed by electronic health record abstraction from time of enrollment to 12 months after patient enrollment |
| Hospice using chart abstraction | 12 months after patient enrollment | Hospice for each patient will be assessed by electronic health record abstraction from time of enrollment to 12 months after patient enrollment |
Countries
United States
Outcome results
None listed