1. A Process Evaluation of a Palliative Care Social Work Intervention for Cancer Patients in Skilled Nursing Facilities.
- Author
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Singh, Sarguni, Dafoe, Ashley, Lahoff, Dana, Tropeano, Laurel, Owens, Bree, Nielsen, Erin, Cagle, John, Lum, Hillary D., Dorsey Holliman, Brooke, and Fischer, Stacy
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RESEARCH funding , *SOCIAL workers , *QUALITATIVE research , *MEDICAL care , *EVALUATION of human services programs , *CANCER patient medical care , *INTERVIEWING , *PILOT projects , *CONTENT analysis , *NURSING models , *CANCER patients , *GOAL (Psychology) , *TREATMENT effectiveness , *UNCERTAINTY , *DECISION making in clinical medicine , *NURSING care facilities , *SOCIAL case work , *THEMATIC analysis , *ONCOLOGY nursing , *PSYCHOLOGICAL stress , *PALLIATIVE care nursing , *MEDICAL needs assessment , *PSYCHOLOGY of caregivers - Abstract
Background: Assessing and Listening to Individual Goals and Needs (ALIGN) is a palliative care social work intervention that aims to improve delivery of goal-concordant care for hospitalized older adults with cancer discharged to skilled nursing facilities. Objective: Explore processes through which ALIGN may improve delivery of goal-concordant care to substantiate the conceptual model grounding the intervention and to inform mechanistic hypotheses of how the intervention might be effective. Design: A process evaluation triangulating findings from patient and caregiver interviews with a matrix analysis of ALIGN social worker notes. Setting/Participants: Patients (n = 6) and caregivers (n = 13) who participated in a single-arm pilot study of ALIGN in the United States and 113 intervention notes (n = 18 patients) written by 2 ALIGN social workers. Measurement: Qualitative thematic content analysis Results: Themes included the following: (1) ALIGN helped reconcile participants' misaligned expectations of rehabilitation with the reality of the patient's progressive illness; (2) ALIGN helped participants manage uncertainty and stress about forthcoming medical decision making; (3) the longitudinal nature of ALIGN allowed for iterative value-based goals of care discussions during a time when patients were changing their focus of treatment; and (4) ALIGN activated participants to advocate for their needs. Conclusions: ALIGN offers support in prognostic understanding, communication, and decision making during a pivotal time when patient and caregivers' goals have not been met and they are reassessing priorities. A larger trial is needed to understand how these processes may improve the ability of participants to make value-based decisions and aide in delivery of goal-concordant care. Clinical Trial Registration Number: NCT04882111. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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