End-of-life discussions with nonmedical workers boost patient satisfaction, study finds

Advanced cancer patients who regularly talked about their care goals with a trained nonclinical worker were more likely to report higher satisfaction levels and  discuss their preferences with physicians, Stanford (Calif.) University School of Medicine researchers report in JAMA Oncology.

The researchers tracked patients at the Veterans Affairs Palo Alto (Calif.) Health Care System for 15 months after they received a stage 3 or 4 cancer diagnosis or were diagnosed with recurrent cancer. Half of the 213 patients were randomly assigned to discuss care goals with a lay health worker for six months.

The findings suggest patients were more at ease with their care decisions and more likely to talk about their care preferences to providers ­when they discussed their preferences soon after their diagnosis with a lay health worker, said lead study author Manali Patel, MD.

The lay health worker participated in an 80-hour online seminar and four weeks of observational training with the hospital's palliative care team. The worker guided patients through a program that addressed questions about their care preferences, including what their understanding of cancer was and how they would want to spend their time if they got sicker. They also created care preferences, identified a surrogate decision-maker and filed an advance directive.

Patients who talked with the lay health worker were more likely to have end-of-life care preferences documented in their EHRs within six months of beginning the conversations — 92 percent of patients compared to 18 percent in the control group. The research team used EHR documentation to determine whether patients discussed these preferences with their physicians. The patients assigned to a lay health worker also said their oncology care was better, giving it an average satisfaction score of 9.16 out of 10, compared to the average of 7.83 in the control group.

"This indicates that patients in the intervention were having a better experience with their providers despite having been prompted and activated to discuss really difficult topics," Dr. Patel said. "This is consistent with what other studies have shown, indicating that patients value honest and open communication regarding their prognosis."

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