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End of LifeLEAPSNCT03699748

Lay Health Worker Engage, Educate, and Encourage Patients to Share

A study testing Lay Health Worker Intervention in people with End of Life and Cancer, run by Stanford University at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of the LEAPS program is to understand how a trained lay health worker who engages with newly diagnosed patients after a diagnosis of an advanced stage of cancer can help to engage patients in advance care planning, improve patient satisfaction with their decision-making, activation, quality of life, and… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
End of Life, Cancer
What is being tested?
Lay Health Worker Intervention
Could I receive a placebo?
No, everyone receives an active treatment
How many people
160 participants
Where
1 siteUnited States
Study dates
1 Nov 2018to 30 Dec 2022
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Newly diagnosed patients with a cancer diagnosis.
  • Patients with any relapse or progressive disease (any cancer diagnosis) as identified by imaging or biopsy and confirmed by physician.
  • The patients must be 18 years or older.
  • Patients must have the capacity to verbally consent.

Who cannot join

  • Inability to consent to the study due to lack of capacity as documented by the referring physician.
  • Patients without a newly diagnosed malignancy or patients without relapse of disease.
  • Patients not eligible for Fund benefits.
  • Patients without a newly diagnosed malignancy or patients without relapse of disease.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Stanford University School of Medicine

    Stanford, California, 94305

Other trials in United States

About this study

The purpose of the LEAPS program is to understand how a trained lay health worker who engages with newly diagnosed patients after a diagnosis of an advanced stage of cancer can help to engage patients in advance care planning, improve patient satisfaction with their decision-making, activation, quality of life, and healthcare resource utilization.

Read the detailed description

Unite Here Health proposes to implement and evaluate several critical elements to be in alignment with the mission of the organization to provide high value care to their members. The Lay Health Worker Engages, Educates, and Encourages Patients to Share intervention is an innovative program that will strengthen provider-patient relationship and facilitate whole person care about matters important to Unite Here Health members who are diagnosed with cancer and important to support network and family. The project is intended to help establish Goals of Care Plan with appropriate documentation, develop, deploy, and evaluate a model of care for persons with cancer that is intended to improve clinical outcomes and experience of care for individuals. The intervention provides patients with lay health coaches who assist patients and their families in discussing goals of care and engage in shared-decision making. The goal of the project is to demonstrate that there is improved documentation of goals of care, patient experiences, patient activation and quality of life outcomes, and that the program helps to reduce utilization of health care resources at the end of life.

Conditions
End of Life, Cancer
Being tested
Lay Health Worker Intervention, Usual Care
Keywords
cancer, end of life, patient-centered
Medical subject headings
Death, Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Lay Health Worker InterventionBehavioural

    Patients randomized into the intervention will be assigned a lay health worker who will contact the patient to begin the intervention. The intervention includes: education on early advance care planning, documenting goals of care, assessing symptoms, and coordinating community services (such as home health, home visits, and home hospice). The intervention is provided along with usual care as provided by Unite Here Health and local oncologists.

  • Usual CareOther

    Usual care as provided by Unite Here Health and local oncologists

Study groups in NCT03699748
Study groupRoleWhat they receive
Intervention Group ArmExperimentalPatients randomized into the intervention will be assigned a lay health worker who will contact the patient to begin the intervention. The intervention includes: education on early advance care planning, documenting goals of care, assessing symptoms, and coordinating community services (such as home health, home visits, and home hospice). The intervention arm will also receive usual care as provided by Unite Here Health and their local oncologists.
Receives: Behavioral: Lay Health Worker Intervention; Other: Usual Care
Control Group ArmActive comparatorThe control group arm will receive usual care as provided by Unite Here Health and their local oncologists.
Receives: Other: Usual Care

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Patient Quality of Life Using the Functional Assessment of Cancer Therapy - General Survey

    Each patient will receive a quality of life survey (Functional Assessment of Cancer Therapy - General Survey) at baseline and 4 months. We will measure the change in quality of life at baseline to 4 months. Scores for quality of life will be assessed using the Functional Assessment of Cancer Therapy - General (FACT-G), a 27-item questionnaire designed to measure four domains of HRQOL in cancer patients: Physical, social, emotional, and functional well-being. Each question is a 5-point likert scale item. Scores range from 0-108. The higher the score, the better the quality of life.

    Measured: Change in Quality of Life from Baseline to 4 Months

Secondary outcomes (28)
  1. Patient Satisfaction With Decision-Making Using the Satisfaction With Decision (SWD) Survey

    The validated Satisfaction with Decision (SWD) Survey was administered to all participants at 4 months after study enrollment. The SWD is a 6-item questionnaire, where respondents rate their agreement with 6 statements (e.g. "I am satisfied that I am adequately informed about the issues important to my decision") on a likert-type scale. Answer options were (1) Strongly Disagree; (2) Disagree; (3) Neither Agree nor Disagree; (4) Agree; (5) Strongly Agree. Responses to each item were averaged to give a score of 0 to 5 where 0 indicated lowest satisfaction and 5 indicated most satisfied with decision making. Scores for each group were averaged at 4 months after study enrollment. Results are expressed as a proportion of participants who responded "strongly agree" at 4 months post-enrollment on the SWD scale, which measured ratings of decision-making. Changes in the proportion of participants who responded "strongly agree" are reflected from baseline to 4 months post-enrollment.

    Measured: Proportion of patients who strongly agree that decisions about their health care were theirs to make at 4 months post study enrollment.

  2. Patient Satisfaction With Decision-Making Using the Satisfaction With Decision Survey

    The validated Satisfaction with Decision (SWD) Survey was administered to all participants at 12 months after study enrollment. The SWD is a 6-item questionnaire, where respondents rate their agreement with 6 statements (e.g. "I am satisfied that I am adequately informed about the issues important to my decision") on a likert-type scale. Answer options were (1) Strongly Disagree; (2) Disagree; (3) Neither Agree nor Disagree; (4) Agree; (5) Strongly Agree. Responses to each item were averaged to give a score of 0 to 5 where 0 indicated lowest satisfaction and 5 indicated most satisfied with decision making. Scores for each group are averaged at 12 months after study enrollment. Results are expressed as a proportion of participants who responded "strongly agree" at 12 months post-enrollment on the SWD scale, which measured ratings of decision-making. Changes in the proportion of participants who responded "strongly agree" are reflected from baseline to 12 months.

    Measured: Proportion of patients who strongly agree that decisions about their health care were theirs to make at 12 months post study enrollment.

  3. Patient Activation Using the Patient Activation Measure Survey

    Each patient will receive the 13-item Patient Activation Measure (PAM-13) at 4 months after study enrollment. This is a validated measure from Insignia Health. Each item is rated on 4-point scale (1 strongly disagree to 4 strongly agree, with additional "not applicable" option). Higher scores indicate greater patient activation. For the PAM-13, minimum score is 0 and maximum is 100. Raw scores are converted into activation levels per the scoring guidelines by Insignia Health for: level 1 Disengaged and Overwhelmed, level 2 Becoming Aware but Still Struggling, level 3 Taking Action and Gaining Control, level 4 Maintaining Behaviors and Pushing Further. Scores for each group will be averaged at 4 months after study enrollment.

    Measured: Change in Patient Activation Measure from baseline to 4 months post enrollment.

  4. Patient Activation Using the Patient Activation Measure Survey

    Each patient will receive the 13-item Patient Activation Measure (PAM-13) at 12 months after study enrollment. This is a validated measure from Insignia Health. Each item is rated on 4-point scale (1 strongly disagree to 4 strongly agree, with additional "not applicable" option). Higher scores indicate greater patient activation. For the PAM-13, minimum score is 0 and maximum is 100 (highest level of activation). Raw scores are converted into activation levels per the scoring guidelines by Insignia Health for: level 1 Disengaged and Overwhelmed, level 2 Becoming Aware but Still Struggling, level 3 Taking Action and Gaining Control, level 4 Maintaining Behaviors and Pushing Further. Scores for each group will be averaged 12 months after study enrollment.

    Measured: Change in Patient Activation Measure from baseline to 12 months post-enrollment.

  5. Patient Quality of Life Using the Functional Assessment of Cancer Therapy - General Survey

    Each patient will receive a quality of life survey (Functional Assessment of Cancer Therapy - General Survey) at 12 months. Scores for quality of life will be assessed using the Functional Assessment of Cancer Therapy - General Survey-General survey. The Functional Assessment of Cancer Therapy - General (FACT-G) is a 27-item questionnaire designed to measure four domains of HRQOL in cancer patients: Physical, social, emotional, and functional well-being. Each question is a 5-point likert scale item. Scores range from 0-108. The higher the score, the better the quality of life.

    Measured: Health-related quality of life at 12 months

  6. Emergency Department Visit (Chart Review)

    Emergency Department Use for each patient will be abstracted by electronic medical record chart review for each patient at 4 months after enrollment.

    Measured: 4 months after patient enrollment

  7. Emergency Department Visit (Chart Review)

    Emergency Department Use for each patient will be abstracted by electronic medical record chart review for each patient at 12 months after enrollment.

    Measured: 12 months after patient enrollment

  8. Emergency Department Visit (Chart Review)

    Emergency Department Use will be abstracted by electronic medical record chart review for each patient who is deceased within 12 months of enrollment, looking at their ER visits during the last 30 days of life.

    Measured: Last 30 days of life up to 12 months from patient enrollment

  9. Hospitalization Visit (Chart Review)

    Hospitalization use for each patient will be abstracted by electronic medical record chart review for each patient at 4 months after enrollment.

    Measured: 4 months after patient enrollment

  10. Hospitalization Visits (Chart Review)

    Hospitalization use for each patient will be abstracted by electronic medical record chart review for each patient at 12 months after enrollment.

    Measured: 12 months after study enrollment

  11. Hospitalization Visits (Chart Review)

    Hospitalization use will be abstracted by electronic medical record chart review for each patient who is deceased within12 months of enrollment, looking at their hospital visits during the last 30 days of life.

    Measured: last 30 days of life

  12. Advance Directive Documentation (Chart Review)

    Advance Directive documentation for each patient will be abstracted by electronic medical record chart review for each patient at 4 months after enrollment.

    Measured: 4 months after patient enrollment

  13. Advance Directive Documentation (Chart Review)

    Advance Directive documentation for each patient will be abstracted by electronic medical record chart review for each patient at 12 months after enrollment.

    Measured: 12 months after patient enrollment

  14. Physician Orders for Life Sustaining Treatment (Chart Review)

    Physician Orders for Life Sustaining Treatment (POLST) documentation for each patient will be abstracted by electronic medical record chart review for each patient at 4 months after enrollment.

    Measured: 4 months after patient enrollment

  15. Physician Orders for Life Sustaining Treatment (Chart Review)

    Physician Orders for Life Sustaining Treatment (POLST) documentation for each patient will be abstracted by electronic medical record chart review for each patient at 12 months after enrollment.

    Measured: 12 months after patient enrollment

  16. Goals of Care Documentation (Chart Review)

    Goals of Care documentation for each patient will be abstracted by electronic medical record chart review for each patient at 4 months after enrollment.

    Measured: 4 months after patient enrollment

  17. Goals of Care Documentation (Chart Review)

    Goals of Care documentation for each patient will be abstracted by electronic medical record chart review for each patient at 12 months after enrollment.

    Measured: 12 months after patient enrollment

  18. Total Costs of Care

    Total Costs of Care will be evaluated by review of claims data from time of enrollment until 12 months post-enrollment

    Measured: 12 months after patient enrollment

  19. Total Costs of Care End of Life

    Total Costs of Care during the last 30 days of life will be evaluated by review of claims data from the 30 days preceding death for those patients who become deceased within 12 months of study enrollment.

    Measured: Last 30 days of life up to 12 months from patient enrollment

  20. Palliative Care Use (Chart Review)

    Palliative Care Use for each patient will be abstracted by electronic medical record chart review for each patient at 4 months after enrollment.

    Measured: 4 months after patient enrollment

  21. Palliative Care Use (Chart Review)

    Palliative Care Use for each patient will be abstracted by electronic medical record chart review for each patient at 12 months after enrollment.

    Measured: 12 months after patient enrollment

  22. Palliative Care Use (Chart Review)

    Palliative Care Use will be abstracted by electronic medical record chart review for each patient who is deceased within12 months of enrollment, looking at their palliative care usage during the last 30 days of life.

    Measured: last 30 days of life

  23. Hospice Use (Chart Review)

    Hospice Use for each patient will be abstracted by electronic medical record chart review for each patient at 4 months after enrollment.

    Measured: 4 months after patient enrollment

  24. Hospice Use (Chart Review)

    Hospice Use for each patient will be abstracted by electronic medical record chart review for each patient at 12 months after enrollment.

    Measured: 12 months after patient enrollment

  25. Hospice Use (Chart Review)

    Hospice Use will be abstracted by electronic medical record chart review for each patient who is deceased within12 months of enrollment, looking at their hospice use during the last 30 days of life.

    Measured: last 30 days of life

  26. Survival (Chart Review)

    Survival rate for patients will be abstracted by electronic medical record chart review at 4 months after enrollment.

    Measured: 4 months after patient enrollment

  27. Survival (Chart Review)

    Survival rate for patients will be abstracted by electronic medical record chart review at 12 months after enrollment.

    Measured: 12 months after patient enrollment

  28. Patient Satisfaction With Decision-Making Using the Satisfaction With Decision Survey

    The validated Satisfaction with Decision (SWD) Survey was administered to all participants at baseline. The SWD is a 6-item questionnaire, where respondents rate their agreement with 6 statements (e.g. "I am satisfied that I am adequately informed about the issues important to my decision") on a likert-type scale. Answer options were (1) Strongly Disagree; (2) Disagree; (3) Neither Agree nor Disagree; (4) Agree; (5) Strongly Agree. Responses to each item were averaged to give a score of 0 to 5 where 0 indicated lowest satisfaction and 5 indicated most satisfied with decision making. Results are expressed as a proportion of participants who responded "strongly agree" at Baseline on the Satisfaction with Decision scale, which measured ratings of decision-making.

    Measured: Proportion of patients who strongly agreed the decisions about their health care were theirs to make at baseline (study enrollment).

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Oct 2018
  2. Study start1 Nov 2018
  3. Primary completion31 Dec 2021
  4. Study completion30 Dec 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Care provider, Investigator, Outcomes assessor
Enrolment
160 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03699748
Sponsor's protocol ID
40447
Other IDs
K23MD013474-01
Acronym
LEAPS
Status last verified
Jul 2023
First submitted
5 Oct 2018
Last updated
7 Jul 2023
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Patel MI, Kapphahn K, Wood E, Coker T, Salava D, Riley A, Krajcinovic I. Effect of a Community Health Worker-Led Intervention Among Low-Income and Minoritized Patients With Cancer: A Randomized Clinical Trial. J Clin Oncol. 2024 Feb 10;42(5):518-528. doi: 10.1200/JCO.23.00309. Epub 2023 Aug 25.

    PubMed 37625110
  • Patel MI, Khateeb S, Coker T. A randomized trial of a multi-level intervention to improve advance care planning and symptom management among low-income and minority employees diagnosed with cancer in outpatient community settings. Contemp Clin Trials. 2020 Apr;91:105971. doi: 10.1016/j.cct.2020.105971. Epub 2020 Mar 4.

    PubMed 32145441

Questions about this trial

What is this clinical trial studying?

A study testing Lay Health Worker Intervention in people with End of Life and Cancer, run by Stanford University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 7 Jul 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 7 Jul 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Patient Quality of Life Using the Functional Assessment of Cancer Therapy - General Survey (time frame: Change in Quality of Life from Baseline to 4 Months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03699748, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Jul 2023.

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