Effect of a Community Health Worker Intervention on Acute Care Use, Advance Care Planning, and Patient-Reported Outcomes Among Adults With Advanced Stages of Cancer: A Randomized Clinical Trial.

Importance: Deficiencies in advance care planning and symptom management are associated with avoidable acute care use among patients with cancer. Community health worker (CHW)-led approaches may be an approach to reduce acute care use but remain untested in community settings. Objective: To determine whether a CHW-led advance care planning and symptom screening intervention can reduce acute care use more than usual care in a community setting. Design, Setting, and Participants: This randomized clinical trial was conducted among patients with newly diagnosed advanced-stage or recurrent solid and hematologic cancers from August 8, 2017, through November 30, 2021. Data analysis was performed November 30, 2021, through January 1, 2022, by intention to treat. Interventions: Participants were randomized 1:1 to usual care (control group) or usual care with the 6-month CHW-led intervention (intervention group). Main Outcomes and Measures: The primary outcome was acute care use. Secondary outcomes included advance care planning documentation, supportive care use, patient-reported outcomes, survival, and end-of-life care use. Results: Among 128 participants, median (range) age was 67 (19-89) years; 61 (47.7%) were female; and 2 (1.6%) were American Indian or Alaska Native, 11 (8.6%) were Asian, 5 (3.9%) were Black, 23 (18.0%) were Hispanic or Latino, 2 (1.6%) were of mixed race, 2 (1.6%) were Native Hawaiian or other Pacific Islander, 86 (67.2%) were White, and 20 (15.6%) did not report race. Intervention participants had 62% lower risk of acute care use than the control (hazard ratio, 0.38; 95% CI, 0.19-0.76) within 6 months. At 12 months, intervention participants had 17% lower odds of acute care use (odds ratio [OR], 0.83; 95% CI, 0.69-0.98), 8 times the odds of advance care planning documentation (OR, 7.18; 95% CI, 2.85-18.13), 4 times the odds of palliative care (OR, 4.46; 95% CI, 1.88-10.55), nearly double the odds of hospice (OR, 1.83; 95% CI, 1.16-2.88), and nearly double the odds of improved mental and emotional health from enrollment to 6 and 12 months postenrollment (OR, 1.82; 95% CI, 1.03-3.28; and OR, 2.20; 95% CI, 1.04-4.65, respectively) than the control. There were no differences in the death (control, 26 [40.6%] vs intervention, 32 [50.0%]). Fewer intervention participants had acute care use (0 vs 6 [23.1%]) in the month before death than the control. Conclusions and Relevance: In this randomized clinical trial, integration of a CHW-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. Trial Registration: ClinicalTrials.gov Identifier: NCT03154190.

Health care coach support to assist with advance care planning and symptom management -A randomized controlled trial.

Advance care planning and symptom management (supportive cancer care) improves patient experiences and reduces acute care use (hospitalizations and emergency department visits). Strong evidence supports team-based approaches to deliver supportive cancer care. However no studies, to our knowledge, have evaluated the use of lay or community health workers to deliver supportive cancer care as compared to usual cancer care. The "Health Care Coach Support" intervention was developed to improve cancer care. The intervention assigns a lay or community health worker "health coach" to all patients newly diagnosed with advanced stages of cancer or patients with recurrent or progressive disease. The intervention aims to educate and activate patients in advance care planning discussions and symptom management with their clinicians. Patients are randomized in a 1:1 allocation to either the 12-month health coach intervention combined with usual oncology care or usual oncology care alone. The primary outcome is to evaluate whether the intervention reduces acute care use measured at 6-months follow-up more than usual care. Secondary outcomes include the effect on acute care, palliative care, and hospice at 12-months follow-up and one month prior to death for patients who die. Additional secondary outcomes include changes in patient satisfaction with decision and patient satisfaction with care from baseline (time of enrollment) to 3-, 6-, 9- and 12-months post-enrollment. The Health Coach Support study addresses an important gap in supportive cancer care by testing whether a team-based approach using non-professional personnel can ensure delivery of these services. Findings can assist in our understanding of how to improve care for patients with cancer. ClinicalTrials.gov Registration #NCT03154190.