Vets Helping Vets Pilot Study
Condition: Advanced Stage Cancer
Study type: Interventional

Summary: 
      The overall goal of this study is to evaluate the feasibility of a veteran patient navigator
      and social work counseling intervention in veterans with advanced stage cancer at the Denver
      VA Medical Center. This is a tiered intervention: patients first receive the veteran patient
      navigator component of the intervention, and then if additional patient needs are present
      they receive the social work counseling component of the intervention. The overall
      intervention will help veterans communicate their care preferences with their providers.This
      is a study of behavioral and care strategy interventions and involves no investigational
      drugs or devices.
    

Detailed description: 
      Many patients with advanced cancer suffer from multiple symptoms including pain and fatigue
      and high rates of depression and anxiety. Many also experience end of life care that is
      inconsistent with their preferences.

      Recent studies of palliative care find that symptoms, depression, and end of life care
      quality improved in patients with advanced cancer with multidisciplinary, specialist
      palliative care compared to usual care. However, these palliative care interventions are
      personnel-intensive and require multiple specialist providers. Because of the costs and
      limited availability of specialist palliative care providers, these interventions cannot be
      spread to the large population of patients with advanced cancer. Thus, there is a need for
      scalable interventions to improve symptoms, depression, and end of life care in this patient
      population.

      Patient navigators, who often belong to the community they serve, have improved rates of
      cancer screening, follow up on abnormal diagnostic tests, and adherence to chemotherapy
      regimens. There has been increasing recognition that palliative care is an important part of
      patient navigation. However, to the best of our knowledge, there have been no studies outside
      our research program that have examined the effects of a peer navigation intervention to
      improve palliative care outcomes.

      While patient navigators hold promise for improving outcomes in patients with advanced
      cancer, both psychosocial care needs and documenting future care preferences and goals may be
      complex. Therefore, the proposed intervention will supplement veteran patient navigators with
      a social work psychosocial intervention. The goal of the proposed study is to evaluate the
      feasibility of a stepped care intervention including a veteran patient navigator and social
      worker.
    

Intervention name(s): Veteran Patient Navigator and Social Work Intervention
Intervention type(s): Behavioral
Intervention description(s): Each study participant will receive a veteran patient navigator intervention which consists of five study visits consisting of advance care planning, pain/symptom management, and education about hospice and palliative care. When clinically indicated, patients will be referred to a social work intervention providing psychosocial care and support.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: advanced stage cancer,; patient navigator,; social work