Improving communication about prognosis on an academic inpatient solid tumor oncology consult service.

Authors

Chrystal Landry

Chrystal Ann Landry

Icahn School of Medicine at Mount Sinai, New York, NY

Chrystal Ann Landry, Alaina J Kessler, Aarti Sonia Bhardwaj, Cardinale B. Smith

Organizations

Icahn School of Medicine at Mount Sinai, New York, NY

Research Funding

Other

Background: As the number of patients living with cancer increases, a growing proportion of hospital inpatients will have an advanced cancer diagnosis. Data suggests that an unscheduled hospitalization for a patient with advanced cancer strongly predicts a median survival of less than 6 months. As hospitalists more frequently become the primary team taking care of admitted cancer patients, communication between a patient's oncologic care team and inpatient primary providers is crucial. We sought to implement and assess the impact of improved oncology consult documentation of patient prognosis on outcomes of advanced cancer patients admitted to our hospitalist medicine teaching services. Methods: We implemented an EMR-based oncology consult note template which required documentation of prognosis, potential future treatment options (if available), and advance care planning. We reviewed all patients with stage IV solid tumors admitted to the hospitalist teaching service for 8 weeks prior and 8 weeks post-template implementation for comparison. We utilized descriptive statistics and chi-squared testing as appropriate for analysis. Results: We evaluated 51 patients in the pre- and 36 patients in the post-intervention groups. Post-intervention, there was an improvement in documentation of prognosis (29.4% vs. 52.8%, p = 0.03), advanced care planning (37.2% vs. 83.3%, p < 0.0001), and in number of palliative care consults (58.8% vs. 83.3%, p = 0.02). On average, goals of care conversations occurred 2 days earlier in the post-intervention group (11 vs 9 days). Similarly, there was a decrease in inpatient chemotherapy administration (3 cases vs. 0), unit codes (2 vs. 0) and in-hospital death (23.5% vs. 11.1%). Conclusions: Creation of an oncology consult note template which incorporates current oncologic prognostic information improved documentation of prognosis and advance care planning as well as outcomes for advanced solid tumor oncology patients and enhanced inter-service communication. Based on these results, continued and targeted interventions are planned to further improve interservice communication.

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Abstract Details

Meeting

2018 Palliative and Supportive Care in Oncology Symposium

Session Type

Poster Session

Session Title

Poster Session B: Advance Care Planning; Caregiver Support; Coordination and Continuity of Care; End-of-Life Care; Models of Care; Survivorship; and Symptom Biology, Assessment and Management

Track

Advance Care Planning,End-of-Life Care,Survivorship,Coordination and Continuity of Care,Symptom Biology, Assessment, and Management,Models of Care,Caregiver Support

Sub Track

Coordination and Continuity of Care

Citation

J Clin Oncol 36, 2018 (suppl 34; abstr 46)

DOI

10.1200/JCO.2018.36.34_suppl.46

Abstract #

46

Poster Bd #

B6

Abstract Disclosures