CHW and Advance Care Planning
Training Community Health Workers to Increase Advance Care Planning among Black Women with Breast Cancer
Principal Investigator: Marcia Tan
Co-Investigator: Patricia Moreno
Our Study
Although breast cancer mortality rates have declined significantly in recent decades, black women, who have a lower incidence of the disease, still die from breast cancer at disproportionate rates compared to white women. Because of the increased likelihood of morbidity and mortality after a breast cancer diagnosis, engaging in advance care planning (ACP) is critical for black women to plan for future medical treatment and end-of-life care. Conversations about ACP have been shown to reduce hospitalizations among patients with advanced disease. However, rates of ACP are low in the U.S., especially among black patients with advanced cancer. Needed are interventions that increase ACP among black patients with breast cancer, a group at high risk of advanced disease and mortality. For our study, we will extract data from the Clinical Research Data Warehouse to identify the occurrence, frequency, and patterns of documenting discussions about advance directives with black women with breast cancer. Data from electronic health records and focus group assessments can help us propose a new model of care that emphasizes early intervention and changes in trajectories of physical, functional, and psychological morbidity.
Future Directions
This project addresses a crucial gap in cancer research and aims to optimize care in black patients with breast cancer. Our goal is to develop a culturally appropriate CHW training for ACP and test its effectiveness on patient readiness and completion of ACP conversations and documentation. Our long-term goal is to develop a CHW-led ACP intervention that is culturally-tailored for black women with breast cancer. This project will provide data on current practices/education of ACP among CHW and providerinformed strategies to develop and incorporate a CHW-led ACP intervention into care.
Specific Aims
- To examine current practices of discussing ACP with black women with breast cancer.
- To examine strategies to facilitate integration of CHW in ACP with black women with breast cancer.