Theory-Based Development of an Implementation Intervention Using Community Health Workers to Increase Palliative Care Use

Boateng Kubi; Zachary O Enumah; Kimberley T Lee; Karen M Freund; Thomas J Smith; Lisa A Cooper; Jill T Owczarzak; Fabian M Johnston

doi:10.1016/j.jpainsymman.2020.02.009

Theory-Based Development of an Implementation Intervention Using Community Health Workers to Increase Palliative Care Use

J Pain Symptom Manage. 2020 Jul;60(1):10-19. doi: 10.1016/j.jpainsymman.2020.02.009. Epub 2020 Feb 22.

Authors

Boateng Kubi¹, Zachary O Enumah¹, Kimberley T Lee², Karen M Freund³, Thomas J Smith⁴, Lisa A Cooper⁵, Jill T Owczarzak⁶, Fabian M Johnston⁷

Affiliations

¹ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
² Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³ Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.
⁴ Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁶ Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁷ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: fjohnst4@jhmi.edu.

Abstract

Context: Opportunities for the use of palliative care services are missed in African American (AA) communities, despite Level I evidence demonstrating their benefits.

Objectives: Single-institution and stakeholder-engaged study to design an intervention to increase palliative care use in AA communities.

Methods: Two-phased qualitative research design guided by the Behavior Change Wheel and Theoretical Domains Framework models. In Phase 1, focus group sessions were conducted to identify barriers and facilitators of palliative care use and the viability of community health workers (CHWs) as a solution. After applying the Behavior Change Wheel and Theoretical Domains Framework to data gathered from Phase 1, Phase 2 consisted of a stakeholder meeting to select intervention content and prioritize modes of delivery.

Results: A total of 15 stakeholders participated in our study. Target behaviors identified were for patients to gain knowledge about benefits of palliative care, physicians to begin palliative care discussions earlier in treatment, and to improve patient-physician interpersonal communication. The intervention was designed to improve patient capability, physician capability, patient motivation, physician motivation, and increase patient opportunities to use palliative care services. Strategies to change patient and physician behaviors were all facilitated by CHWs and included creation and dissemination of brochures about palliative care to patients, empowerment and activation of patients to initiate goals-of-care discussions, outreach to community churches, and expanding patient social support.

Conclusion: Use of a theory-based approach to facilitate the implementation of a multi-component strategy provided a comprehensive means of identifying relevant barriers and enablers of CHWs as an agent to increase palliative care use in AA communities.

Keywords: African American; Behavior Change Wheel; Palliative care; Theoretical Domain Framework; disparities; theory.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Community Health Workers*
Focus Groups
Humans
Motivation
Palliative Care*
Qualitative Research

Grants and funding

K08 HS024736/HS/AHRQ HHS/United States