Outpatient Advance Care Planning for Patients with Metastatic Cancer: A Pilot Quality Improvement Initiative

Obel, Jennifer; Brockstein, Bruce; Marschke, Michael; Robicsek, Ari; Konchak, Chad; Sefa, Meredith; Ziomek, Nicole; Benfield, Tiffany; Peterson, Carrie; Gustafson, Cory; Eriksson, Joann; Harper, Abigail; Tabachow, Cory; Raymond, Michael J.; Hensing, Thomas A.

doi:10.1089/jpm.2014.0085

Cited by 26 publications

(42 citation statements)

References 23 publications

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“…Substitute decision‐maker is a trusted individual named by the patient (Zhou et al, 2010). Different names were used, like power of attorney for health care (Hu et al, 2010; Obel et al, 2014; Zhou et al, 2010), healthcare proxy (Thomas et al, 2019; Zhou et al, 2010) or healthcare surrogate (Bickel et al, 2016).…”

Section: Resultsmentioning

confidence: 99%

Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective

Kuusisto

Santavirta

Saranto

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To describe advance care planning (ACP) for patients with cancer in palliative care from professionals' perspective. Background The number of patients with cancer is increasing. Palliative care should be based on timely ACP so that patients receive the care they prefer. Design A scoping review. Methods A systematic literature search was conducted in January 2019. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist was used. The methodological quality of the studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Data were analysed with content analysis. Results Of 739 studies identified, 12 were eligible for inclusion. The settings were inpatient and outpatient facilities in special and primary care including oncology, palliative and hospice care. ACP consisted of patient‐oriented issues, current and future treatment, and end‐of‐life matters. The participants were nursing, medical or social professionals. ACP conversations rarely occurred; if they did, they took place at the onset, throughout and late in the cancer. Conclusions Professionals could not separate day‐to‐day care planning and ACP. ACP documentation was scattered and difficult to find and use. Professionals were unfamiliar with ACP, and established practices were lacking. ACP conversations mostly occurred in late cancer. Further research clarifying concepts and exploring the significance of ACP for patients and relatives is recommended. Relevance to clinical practice Our results support the use of ACP by a multidisciplinary team from the early stages of cancer as a discussion forum around patients' wishes and choices. We showed the need to raise professionals' awareness of ACP. Education and appropriate data tools for ACP are important as they may reduce reluctance and promote ACP use. This paper contributes to the wider global clinical community by pointing out the importance of standardising ACP contents and practices.

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Section: Resultsmentioning

confidence: 99%

Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective

Kuusisto

Santavirta

Saranto

et al. 2020

Journal of Clinical Nursing

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“…A study by Obel and colleagues 16 at the Kellogg Cancer Center showed that outpatient acp discussions were feasible in patients with recently diagnosed stage iv lung cancer. Improvement in workflow and involvement of motivated providers were key elements that resulted in almost 70% of patients having notes about advance directives in their medical record.…”

Section: Scope Of the Problemmentioning

confidence: 99%

Toward Improved Goals-Of-Care Documentation in Advanced Cancer: Report on the Development of a Quality Improvement Initiative

et al. 2017

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“…As a quality improvement initiative at NorthShore, Obel et al created and implemented an ACP navigator in the electronic health record (EHR; EPIC, Verona, Wisconsin), coupled with tools (including an ACP guidebook and educational video) to facilitate these discussions, small group training sessions on how to conduct ACP given by palliative care providers, and nursing support to aid efficient delivery and completion of ACP. 9 All cardiologists and oncologists at NorthShore were trained in the use of these tools and the ACP navigator and were strongly encouraged to incorporate these novel workflow changes into their daily practices.…”

Section: Introductionmentioning

confidence: 99%

Perspectives of Health-Care Providers Toward Advance Care Planning in Patients With Advanced Cancer and Congestive Heart Failure

Chandar

Brockstein

Zunamon

et al. 2016

Am J Hosp Palliat Care

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Attitudes toward ACP implementation vary considerably by medical specialty and medical condition, with oncologists in this study tending to feel more personal responsibility for these discussions with patients having cancer than cardiologists with their patients having heart failure. Robust implementation of ACP across the spectrum of medical diagnoses is likely to require a true collaboration between office-based PCPs and specialists in both the inpatient and the ambulatory settings.

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Outpatient Advance Care Planning for Patients with Metastatic Cancer: A Pilot Quality Improvement Initiative

Abstract: Outpatient ACP is feasible early in the care of patients with stage IV cancer through systematic improvement in workflow and motivated providers. Education and infrastructure were pivotal to routine development of advance care plans.

Cited by 26 publications

References 23 publications

Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective

Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective

Toward Improved Goals-Of-Care Documentation in Advanced Cancer: Report on the Development of a Quality Improvement Initiative

Perspectives of Health-Care Providers Toward Advance Care Planning in Patients With Advanced Cancer and Congestive Heart Failure

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