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# Conversations with a Non-Clinical Worker Enhances End-of-Life Cancer Care

END-OF-LIFE cancer care is enhanced and costs less when patients discuss their preferences with a trained non-clinical worker soon after diagnosis, a study from Stanford University, California, USA, has suggested. The findings indicate that implementing such an approach for seriously ill cancer patients would improve satisfaction with treatment and reduce rates of hospitalisation.

### Discussing Preferences

In a pilot study, a cohort of 213 patients with Stage 3 or 4 cancer or with recurrent cancer were followed for 15 months after diagnosis. Half were randomised to discuss their treatment goals over a 6-month period with a non-clinical worker. This worker participated in telephone and face-to-face conversations with the patients that addressed questions such as ‘What is important to you?’, ‘Have you thought about a time when you could be sicker?’, and ‘How would you want to spend your time in that situation?’

These questions and topics were discussed at multiple timepoints and revisited when unexpected events occurred, such as an emergency department visit, in case the views of the patients had changed.

### Improved Outcomes

The team observed that 92% of patients assigned with a lay health worker had their end-of-life care preferences documented in their electronic health records within 6 months of the conversations taking place; this compared to just 18% of the non-intervention group. This suggests that the patients who spoke with a trained non-clinical worker were more inclined to inform their doctors about their treatment goals.

Patients in the intervention group also had higher average satisfaction scores than the control group: 9.16 compared with 7.83 out of 10. “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”, commented lead author Dr Manali Patel, Stanford University. “This is consistent with what other studies have shown indicating that patients value honest and open communication regarding their prognosis.”

### Lower Costs

In the final 30 days of the lives of patients who died during the study, those who discussed their preferences were six-times less likely to be hospitalised or visit the emergency department than the control group, and twice as likely to use hospice services. This meant the median care costs were markedly reduced for this cohort compared with the control in those 30 days: $1,048 and$23,482, respectively.

While the results are very promising, the researchers cautioned that further studies are required to confirm the efficacy of this approach.

James Coker, Reporter