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Bicultural and bilingual palliative patient navigator interventions may be a key to improving access to goal concordant care among Hispanic populations with serious illness, according to recent research.
Researchers in a recent clinical trial sought to address whether integration of bilingual patient navigation interventions could improve palliative care outcomes in Hispanic patients with serious, noncancer illnesses.
Published in JAMA Internal Medicine, the research included an analysis of 209 Hispanic seriously ill adults without cancer conditions. Those who received the bilingual, bicultural patient navigator interventions were more likely to forgo aggressive treatment or intensive care at the end of life compared to others. These patients also had improved access and utilization of advance care planning (ACP) services.
Though quality of life (QOL) scores were not impacted by the interventions, the clinical trial illustrates the significance of culturally appropriate communication when it comes to improving awareness, access and outcomes among underserved populations, according to the researchers. Researchers included those from the University of Colorado, Kaiser Permanente Colorado and the Denver Health and Hospital Authority.
“A culturally tailored patient navigator intervention can help improve some palliative care–related outcomes for Hispanic patients with serious medical illness,” researchers wrote.
To determine effectiveness of lay patient navigators, researchers utilized a palliative care intervention method piloted in 2014. Similar to the Apoyo con Cariño patient navigation intervention pilot, researchers in the clinical trial study analyzed patient data around quality of life scores, advance care planning engagement surveys, as well as pain and symptom control assessments.
The study compared two groups of Hispanic patients across Colorado-based community health care systems, nonprofit providers and academic settings from January 2017 to January 2021. Data were collected and analyzed from July 2022 to July 2023 of self-identifying Hispanic patients with serious noncancer life-limiting illnesses.
Both groups received culturally tailored educational materials, but only one group also received guided discussions with bicultural, bilingual patient navigator teams.
Nearly half, or 44.2%, of patients receiving the interventions were referred to hospice when eligible, compared to 21.2% of those who did not. A large majority (84.8%) of patients who did receive the bicultural interventions received aggressive care at the end of life, compared to 64.3% of those who did.
Additionally, individuals with patient navigator interventions had “significantly greater increases” in mean advance care planning engagement. More than half (59.6%) of seriously ill Hispanic patients in the intervention group completed some form of advanced directive documentation, compared to 26.9% among others.
“In this randomized clinical trial, a culturally tailored patient navigator intervention did not improve QOL for patients,” researchers wrote. “However, the intervention did increase ACP engagement, [advance directive (AD)] documentation and hospice utilization in Hispanic persons with serious medical illness.”
The clinical trial study results show impactful culturally appropriate communication can be on the decisions made among diverse seriously ill patient populations, according to researchers. Receiving culturally individualized educational materials about serious illness and end-of-life care options can help patients and families make informed decisions that better align with their beliefs and values, researchers indicated.
“Disparities persist across the trajectory of serious illness, including at the end of life,” the researchers stated. “Patient navigation has been shown to reduce disparities and improve outcomes for underserved populations.”