Table 2 Evaluation Measures Organized within the REAIM Framework

Aim 1: Evaluation of Intervention Implementation

CHW Training/

Orientation

Attendance rates for program orientation, trainings and meetings among CHWs and clinical team; Pre/post-test change in CHW’s palliative care knowledge and perceptions; CHW’s skills performance and perceptions of training content and format post-training

Minutes from home-based palliative program meetings

TMC Co-Is will administer survey pre-post training & skills checklist post-training

Adoption

Implementation

CHW Role

Frequency of patient visits; assessment of patient problems (e.g. pain, transportation, depression); CHW actions (education, scheduling appt., obtaining morphine); problem resolution (pain control); frequency of debriefings w/ clinicians

Review of toolkit log data

Implementation,

Adoption

Study Recruitment

Number, % and characteristics of eligible patients who are offered study participation, consent and complete/drop-out; reasons for screen failures and dropout

TMC research coordinator will complete recruitment and enrollment logs

Reach; Implementation

Stakeholder Perceptions

Perceptions of Pal-Care intervention implementation (e.g. CHW role and responsibilities, teamwork, communication, workflow; barriers, facilitators and optimal practices); intervention feasibility, acceptability and usefulness; potential for sustainability and scale up (with comparison by stakeholder type, as relevant)

Minutes from home-based palliative program meetings;

Post-intervention interviews with CHWs, clinical team, patients/caregivers (§ Appendices)

Implementation,

Adoption,

Maintenance

Fidelity to Study Protocol

Participant recruitment per inclusion criteria; data collection per protocol (% completion of patient surveys and each type of toolkit form), regular meetings with research team/sites with high attendance; timely reporting of adverse events

Patient record reviews, review of completed surveys/toolkit forms, meeting minutes

Implementation

Aim 2: Evaluation of Intervention Effectiveness

Patient

Outcomes

Patient surveys (§ Appendices) will be conducted with intervention/control groups to assess palliative needs via African Palliative Outcomes Scale; [17] QOL via WHO QOL Scale; [18,19,20] cancer symptoms via Edmondton Symptom Scale [21, 22] and patient care experience via FAM-Care Scale [23, 24].

Palliative care toolkit forms [12] filled out by CHWs measure outcomes for intervention group: use of pain, anti-emetics and laxative medications; performance status; survival days in palliative service; location of death.

TMC research coordinator will administer surveys by phone after baseline study visit and at 1 and 3 months

Review of toolkit form data

Effectiveness

Effectiveness

Health System

Outcomes

-Number of medical visits per patient and distribution of these visits by type (cancer center, caregiver proxy and home-based services); healthcare service costs

-Navigation program continuation status 6-months post grant;

Inquiries by potential navigators/organizations re: participation

Chart review of cancer center records (plus navigation logs for navigated patients)

Post project qualitative interviews

Reach; Effectiveness

Maintenance