I-DO GOC: Improving documentation in oncology with goals of care.

Authors

null

Francisco Martinez

Department of Hematology/Oncology, The Permanente Medical Group, San Francisco, CA

Francisco Martinez, Karen Hauser, Ashley Aller, Aida Shirazi, Amy Ying Ju Lin, Peggy T Lim, Tyler Jones, Hannah Whitehead, Amita Risbud, Sue May Yen, Raymond Liu, Jed Abraham Katzel

Organizations

Department of Hematology/Oncology, The Permanente Medical Group, San Francisco, CA, Department of Medicine, Kaiser Permanente Northern California, San Francisco, CA, Department of Graduate Medical Education, Kaiser San Francisco, San Francisco, CA, The Permanente Medical Group (Kaiser Permanente), San Francisco, CA, The Permanente Medical Group Consulting Services, Oakland, CA, Kaiser Permanente San Francisco Medical Center, San Francisco, CA

Research Funding

No funding received
None.

Background: Goals of Care (GOC) discussions are part of high-quality care, allowing clinicians to align the care provided with what is most important to the patient. Early GOC discussions are associated with better quality of life, reduced use of futile medical care, and enhanced goal-concordant care. In order to increase GOC documentation within the electronic medical record (EMR), the Kaiser Permanente San Francisco medical oncology practice began an ASCO Quality Training Program initiative in January 2022 to increase oncologist discussion and documentation of GOC in advanced cancer patients. Methods: Baseline data on the frequency of GOC discussions was obtained through a structured chart review with a historical cohort of stage IV or recurrent cancer patients > 18 years old between 1/1/2020-6/1/2020. The project aimed to improve accessible GOC documentation from a baseline of 0% to a goal of 25% among stage IV or recurrent cancer patients seen by an oncologist between 1/2022 and 5/14/2022. Patients with hematologic malignancies were excluded. Oncologists were instructed to use a templated GOC automated phrase (Smartphrase) that consolidated content into a visible, centralized EMR location. The frequency of GOC Smartphrase usage among oncologists was tracked monthly through a customized dashboard. Plan-Do-Study-Act cycles included education on GOC documentation and monthly feedback for oncologists on performance. Results: Review of the 2020 historical cohort revealed no structured or accessible GOC documentation by oncologists. During the intervention period, 300 Stage IV and recurrent cancer patients were eligible for GOC documentation. The median age of the intervention group was 70 years, with the most common types of cancers represented: Prostate (21%), Breast (19%), and Lung (17%). Our study cohort included a diverse population: White (45%), Asian (36%), Black/African American (11%), and Hispanic (7%). Between 1/1/2022 to 5/14/22, 142 (47%) patients had at least one documented GOC conversation, exceeding the target of 25%. 100% of these structured conversations were viewable in the designated area in the EMR. Conclusions: Our ASCO Quality Training Program initiative successfully increased oncologists' overall number of GOC conversations and made those conversations more easily accessible to the entire care team. Our process for standardizing the documentation of GOC conversations was based on the use of a Smartphrase that helped organize the collected information within the EMR. During the study period, we increased the documented GOC rate from 0% to 47%. This can improve patient and physician satisfaction, as well as improve goal concordant care for patients with advanced cancer. Further efforts will be focused on sustaining these initial gains in GOC documentation and on promoting their broader use across our organization.

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Abstract Details

Meeting

2022 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B

Track

Palliative and Supportive Care,Technology and Innovation in Quality of Care,Quality, Safety, and Implementation Science

Sub Track

Application of Quality Improvement Tools

Citation

J Clin Oncol 40, 2022 (suppl 28; abstr 314)

DOI

10.1200/JCO.2022.40.28_suppl.314

Abstract #

314

Poster Bd #

C21

Abstract Disclosures

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