In a single-institution study reported in JAMA Oncology, Manali I. Patel, MD, MPH, MS, and colleagues found that the addition of a community health worker–led intervention to usual care resulted in reduced use of acute care, increased advance care planning documentation, increased use of palliative care and hospice, and improved reported mental and emotional health among patients with advanced cancer treated in the community setting.
Manali I. Patel, MD, MPH, MS
Study Details
The trial—conducted between August 2017 and November 2021—included 128 patients with newly diagnosed advanced-stage or recurrent solid or hematologic cancers treated at the Virginia K. Crosson Cancer Center in Fullerton, California. Patients were randomly assigned to usual care with (n = 64) or without (n = 64) a 6-month community health worker–led intervention.
The intervention included two part-time female community health workers who engaged in twice-monthly telephone segments providing education on goals of care and advance directives and tailored guidance on how to engage in advance care planning conversations with clinical teams and document advance directives. Weekly symptom screening was performed using the Edmonton Symptom Assessment System, with referral when appropriate to a supervising nurse, who conducted clinical intervention. The community health workers also engaged patients 1:1 in open-ended discussions. The primary outcome measure was acute care use at 6 months.
Key Findings
Over the 6-month intervention period, acute care was used by 18.8% of the intervention group vs 40.6% of the control group (hazard ratio = 0.38, 95% confidence interval [CI] = 0.19–0.76).
At 12 months:
- Acute care was used by 32.8% vs 51.6% of patients (odds ratio [OR] = 0.83, 95% CI = 0.69–0.98).
- Advance care planning documentation was completed by 89.1% vs 53.1% (OR = 7.18, 95% CI = 2.85–18.13).
- 85.9% vs 57.8% used palliative care (OR = 4.46, 95% CI = 1.88–10.55).
- 31.3% vs 15.6% used hospice (OR = 1.83, 95% CI = 1.16–2.88).
More patients in the intervention group highly rated their overall mental and emotional health status at 6 months (OR = 1.82, 95% CI = 1.03–3.28) and at 12 months (OR = 2.20, 95% CI = 1.04–4.65).
Death occurred in 32 patients (50.0%) in the intervention group vs 26 (40.6%) in the control group (P = .56). Fewer patients in the intervention group had acute care use in the month before death (0 vs 6, 23.1%).
The investigators concluded, “In this randomized clinical trial, integration of a community health worker–led intervention into cancer care reduced acute care use and is one approach to improve cancer care delivery for patients with advanced stages of disease in community settings.”
Manali I. Patel, MD, MPH, MS, of the Division of Oncology, Stanford University, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the Providence St. Jude Memorial Foundation, California Health Care Foundation, and others. For full disclosures of the study authors, visit jamanetwork.com.
