In a study published online in JAMA Oncology, the research team found that Latinos with advanced cancer who were assigned their own patient navigator to help them with issues such as end-of-life care planning, pain management, and hospice were more likely to complete an advanced directive than their counterparts who were not assigned a patient navigator.
Lay patient navigators can improve advanced care planning in populations that are very reticent to engage in such planning, according to new research.
"Helping patients do advanced care planning, which was one of our objectives, is a great outcome, and I feel very proud of the work that our navigators were able to do," said Aurora.
They were accommodating in completing advanced directives and ensuring they got placed in the electronic records," lead author Tracy M. Fischer, MD, University of Colorado School of Medicine," Aurora, told.
Having a patient navigator was also associated with improved physical symptoms. However, the intervention did not affect pain management, hospice use, or overall quality of life.
In an interview, Fischer commented that her interest in improving access to care for Latino adults with advanced cancer stems from her travels to Central and South America during a gap year between her residency and fellowship training.
"I became very interested in issues surrounding social justice, Latino culture, and the use of laypersons from the community to improve health outcomes. Having community health workers engage with patients is a way to establish trust and help ensure that the values of the culture are being integrated into the care of the patient," Fischer said.
Patients and families
Many hospitals have patient navigators who help patients get to clinic appointments and undergo laboratory tests. But in this study, the patient navigators were lay people who had received training on working with patients and families to reduce barriers to care.
"Our patient navigators meet with patients and families in their homes to talk about pain control, quality of life, advance care planning, and medical decision making," Fischer said.
"They also let patients know what hospice is in a way that is concordant with Latino cultural values," Fischer said. One issue that emerged was that, in Latino culture, the word "hospicio" translates poorly.
"When we worked with Spanish speaking patients in our focus group, we found out that the way we were translating the word 'hospicio' meant that it was an orphanage or a place where one could drop off a loved one when they could not take care of them anymore. This had a very negative translational meaning to patients," she explained.