Background: Advance Care Planning (ACP) is an integral part of the journey of a cancer patient. Our goal was to increase awareness, normalize conversations, and improve documentation of Advance Care Planning needs in Oncology Patients. Methods: 2021 Q4: Identified MIPS 047 Advance Care Planning and PIMSH1 Advance Care Planning in Stage 4 disease as an opportunity to improve ACP. Forms updated to include ACP information on New Patient Paperwork, including a Consent to Communicate, which included detailed information on Surrogate Decision Maker designation. Q1: Letter to the patient was added to New Patient Packet with information on Advance Directive (AD) and POLST for all patients. Standardized the use of Oregon Health Authority AD and User Guide, available in multiple languages. Q2: Educated Front Desk staff to include screening for Surrogate Decision Maker. Educated MA team on screening for ACP needs, appropriate documentation in EHR and State POLST Registry, and on appropriate follow up for patients requesting ACP counseling Q3: The US Oncology Network provided a Difficult Conversations Workshop and ACP training with Support Services Team, including Patient Navigation Team and Social Workers. Social Workers provided ACP visits. Q4: Standardized Nurse Navigator visits to include ACP needs and resources at C1D1 education or when referred. 2023: Changes to workflow are on-going and fine tuning occurs with review of metrics and a Continuous Quality Process Improvement plan. Results: See table. Conclusions: MIPS 047 has risen from 42.8% in 2021 to 94.4% 2023 YTD, which includes patients 65 and older that have been screened for ACP needs, have designated a Surrogate Decision Maker, or have a copy of an AD or POLST on file in the EHR. This has increased from 21.8% to 77.6%. Early and often conversations around ACP has markedly increased ACP information and education for a large majority of our patients. This team-based approach has impacted increase in metrics and understanding.