Toward a Common Goal: A Collaborative Palliative Care and Oncology Pilot Study to Expand Advance Care Planning (QI423)

• Published in: Journal of pain and symptom management 2022-05, Vol.63 (5), p.897-898
• Main Authors: Collins, Elizabeth, Cammy, Becky, Csik, Valerie, Garber, Gregory, Handley, Nathan, McGrath, Lauren, Wilde, Lindsay, Worster, Brooke
• Format: Article
• Language: English
• Subjects: Advance directives; Cancer; Care plans; Death & dying; Documentation; Health care; Interdisciplinary aspects; Medical referrals; Oncology; Palliative care; Polls & surveys; Quality of life; Visits
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2022.02.110

1. Identify care gaps that exist in advance care planning (ACP) and its documentation in the electronic medical record (EMR) 2. Describe a novel, interdisciplinary approach to comprehensive ACP in oncology At our cancer center, 48% of patients who have a palliative intent for cancer treatment do not have any form of advance directive (AD) at the time of death. 70% of patients who do have an AD lack easily accessible documentation of an ACP conversation in the EMR. Robust ACP conversations have been shown to be associated with less aggressive medical care near death and improved quality of life.1,2 80% of identified eligible patients will complete a dedicated ACP visit. This visit will be documented in a templated note in the EMR. A joint palliative care and oncology workgroup was formed to address ACP needs among patients. The group created a workflow for referrals to ACP visits and an EMR-based template for the visits. New patients with acute myeloid leukemia or genitourinary cancer were selected to participate in the pilot. After their visits, patients were asked to complete a survey on their experience. Over 3 months, 24 patients were identified. 22 patients (92%) were referred to the dedicated visit, 13 (54%) completed the visits, and 3 (12.5%) completed the survey. All 13 patients had a templated documentation of their discussion in the EMR after their visits. Qualitative data from the few surveys are limited, but comments have been positive. Development of an interdisciplinary workgroup, referral workflow, and EMR template for structured ACP visits resulted in high rates of referral to these visits and universal documentation in the EMR for patients who completed the visits. Future work will focus on increasing visit completion among referred patients and expanding to other patient groups.