Advance care planning in metastatic cancer patients: A quality improvement initiative.

Authors

null

Steven Oppenheim

Cedars Sinai Medical Center, West Hollywood, CA

Steven Oppenheim, Robert A. Figlin, Edward G. Seferian, Kevin S. Scher, Margaret R Reed, Scott Irwin, Bradley T. Rosen

Organizations

Cedars Sinai Medical Center, West Hollywood, CA, Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, Cedars Sinai, West Hollywood, CA, Tower Hematology Oncology Medical Group, Beverly Hills, CA, Cedars-Sinai Medical Center, Los Angeles, CA

Research Funding

No funding received
None

Background: The initiative aimed to increase the rate of advance care planning (ACP) activities for outpatients with metastatic cancer. Methods: The project was sponsored by the institution’s Quality Committee in collaboration with the Cancer Quality Committee, Oncology Division, Tumor Boards, and Medical Group. Metastatic cancer patients were identified by ICD-10 coding and later by oncologist electronic health record (EHR) documentation of metastatic status. ACP activities were defined as either an ACP note, Advance Directive, Physician’s Order for Life Sustaining Therapy, or a palliative medicine (PM) consultation. The EHR was revised to include a section for ACP documentation. Quarterly reports were sent to oncologists with data comparing their rate of ACP activities for patients with metastatic cancer with peers. Oncologists’ identities were initially blinded and later unblinded. Oncologists received a monthly list of their metastatic patients without any ACP activities. Results: The study covered 5201 unique cancer patients cared for by 60 oncologists each year. The rate of ACP activities for metastatic cancer patients increased from 37% in 2017 to 57% at the end of 2020. Data on individual ACP activities are pending analysis. The ACP activities were driven most by PM consultations, which rose from 12% to 39%. Conclusions: This initiative successfully increased ACP activities for patients with metastatic cancer. ACP activities are an essential step to achieve goal concordant care. Given that the main driver of increased ACP activities was PM referrals, further work will be required to strengthen oncologist’s ACP skills and improve access to PM.

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Abstract Details

Meeting

2021 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session A: Cost, Value, and Policy; Health Equity and Disparities; Patient Experience

Track

Cost, Value, and Policy,Technology and Innovation in Quality of Care,Health Care Access, Equity, and Disparities,Patient Experience,Quality, Safety, and Implementation Science

Sub Track

Integration and Delivery of Palliative and Supportive Care

Citation

J Clin Oncol 39, 2021 (suppl 28; abstr 22)

DOI

10.1200/JCO.2020.39.28_suppl.22

Abstract #

22

Poster Bd #

B5

Abstract Disclosures

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