Journal of palliative medicine
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Introduction: High-quality communication and shared decision making (SDM) are crucial elements of effective patient care. SDM conversations are intimate and logistically challenging to capture. Evaluating alternative methods to effectively observe how physicians conduct these conversations may improve research efforts in this core discipline of medicine. ⋯ Results: Thirty-seven transplant hematologists (A) and 21 medical oncologists (B) from across the United States successfully completed a telemedicine encounter with a trained actor, allowing for qualitative analysis of their SDM conversations. Discussion: Simulated telemedicine encounters are a feasible method for studying how a broad sample of subspecialty physicians conduct difficult conversations, such as emotionally fraught SDM conversations. This model could improve understanding of the current practice of SDM, identify opportunities for improvement, and serve as a framework for ongoing research of physician communication practices.
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Context: Specialty palliative care has been associated with cost savings at the end of life, while patient navigators have been independently associated with cost savings due to screening and treatment early in the course of disease. Evidence is limited regarding patient navigators and cost savings at the end of life. Objectives: To determine the cost-effectiveness of a lay patient navigator intervention in improving palliative care outcomes for Hispanic persons with serious noncancer illness. ⋯ Spending was lower (p = 0.05) in the last 30 days of life for individuals who died in hospice ($9,403) than those who did not ($19,032), and persons in the intervention had a significantly (p = 0.03) higher probability of dying in hospice (63%) versus those in the control group (37%). Conclusion: Study results support the use of a culturally tailored lay patient navigator intervention to improve palliative care outcomes. The results suggest a potential return on investment for culturally appropriate lay patient navigator interventions of 4:1.