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

Harle, Ingrid; Karim, Safiya; Raskin, William; Hopman, Wilma M.; Booth, Christopher M.

doi:10.3747/co.24.3754

Cited by 15 publications

(15 citation statements)

References 19 publications

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“…In this cohort of patients, pre‐study GOC completion rate was high compared to other studies, 18,24 albeit in keeping with previous inpatient studies from our centre 20 . The combination of a communication skills refresher course and verbal prompting of the patients' current GOC improved documentation of GOC during routine clinic reviews of patients with advanced lung cancer.…”

Section: Discussionsupporting

confidence: 82%

“…Recognising the barriers to advance care planning, multiple studies have reviewed the impact of various interventions to improve this outcome for patients with life‐threatening illnesses 17–19 . In one study, use of a communication‐priming tool was shown to improve Goals of Care (GOC) discussions from 31% to 74% and documentation of treatment limitations from 17% to 61%, without any impact on patients' depression or anxiety 17 …”

Section: Introductionmentioning

confidence: 99%

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Implementing ‘Goals of Care’ discussion and palliative care referral for patients with advanced lung cancer: an outpatient‐based pilot project

Conduit

Thompson

Thomas

et al. 2021

Internal Medicine Journal

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Background Early involvement of palliative care and advance care planning improves quality‐of‐life outcomes and survival for patients with advanced lung cancer; however, there are barriers to implementation. Aims A single‐centre prospective audit reviewing ‘Goals of Care’ (GOC) form completion and palliative care referrals in an oncology clinic was undertaken with the aim of increasing GOC completion and palliative care referrals for patients with advanced lung cancer. Methods Involved physicians attended a communication skills course and then received a communication‐priming intervention. Clinicopathological factors associated with GOC completion and palliative care referral were explored. Results A total of 84 patients receiving palliative treatment for advanced lung cancer was enrolled. Clinicopathological factors, such as poorer performance status, were associated with higher likelihood of GOC completion (P = 0.018) prior to the intervention. Male sex (P = 0.023), absence of sensitising epidermal growth factor receptor mutation or anaplastic lymphoma kinase rearrangement (P = 0.017), type of systemic therapy (P = 0.031) and poorer performance status (P < 0.001) were associated with higher likelihood of palliative care referral. The intervention improved GOC completion (relative risk (RR) 1.29, P = 0.004); however, this was not sustained in a follow‐up audit (RR 0.98, P = 0.92) and there was no change in palliative care referral rate (RR 2.5, P = 0.16). Predictors of palliative referral following clinical review included age (RR 1.16, P = 0.001), male sex (RR 14.2, P = 0.02) and poorer performance status (RR 1.76, P < 0.001). Conclusions Communication‐priming interventions can improve GOC completion for patients with advanced lung cancer. Further investigation is needed to pursue sustainable options for managing this complex patient group and improve guideline‐adherence and patient care.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Implementing ‘Goals of Care’ discussion and palliative care referral for patients with advanced lung cancer: an outpatient‐based pilot project

Conduit

Thompson

Thomas

et al. 2021

Internal Medicine Journal

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“…A recent audit of patients with metastatic lung, pancreatic, colon, and breast cancer receiving palliative chemotherapy at the Cancer Centre of Southeastern Ontario (CCSEO) between 2010 and 2015 revealed that only 6% of patients had a documented GOC discussion and only 47% of patients had been referred to PC. 10…”

Section: Problem Descriptionmentioning

confidence: 99%

Documenting Goals of Care Among Patients With Advanced Cancer: Results of a Quality Improvement Initiative

Karim¹,

Harle²,

O’Donnell³

et al. 2018

JOP

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“…Prior studies have shown that palliative care can facilitate the receipt of goal-concordant care. [20][21][22] At the end of life, patients who have goals-of-care discussions are more likely to receive comfort-focused care and less likely to experience an in-hospital death. 23 These outcomes are associated with improved satisfaction with care among bereaved caregivers.…”

Section: Discussionmentioning

confidence: 99%

Natural Language Processing to Assess Palliative Care and End-of-Life Process Measures in Patients With Breast Cancer With Leptomeningeal Disease

Brizzi

Zupanc

Udelsman

et al. 2019

Am J Hosp Palliat Care

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Background: Palliative care consultation during serious life-limiting illness can reduce symptom burden and improve quality of care. However, quantifying the impact of palliative care is hindered by the limitations of manual chart review and administrative coding. Objectives: Using novel natural language process (NLP) techniques, we examined associations between palliative care consultations and performance on nationally endorsed metrics for high-quality end-of-life (EOL) care in patients with leptomeningeal disease (LMD) secondary to metastatic breast cancer. Methods: Patients with breast cancer with LMD were identified using administrative billing codes and NLP review of magnetic resonance imaging reports at 2 tertiary care centers between 2010 and 2016. Next, NLP was used to review clinical notes to (1) determine the presence of palliative care consultations and (2) determine the performance of process measures associated with high-quality EOL care, including discussions of goals of care, code status limitations, and hospice. Associations between palliative care consultation and documentation of EOL process measures were assessed using logistic regression. Results: We identified 183 cases of LMD. Median age was 56 (interquartile range [IQR]: 46-64) years and median survival was 150 days (IQR: 67-350). Within 6 months of diagnosis, 88.5% of patients had documentation of ≥1 process measure, including discussions of goals of care (63.4%), code status limitations (62.8%), or hospice (72.1%). Palliative care consultation was a predictor of subsequent documentation of goals of care (odds ratio [OR], 3.15; 95% confidence interval [CI], 1.58-6.27) and hospice discussions (OR, 4.61; 95% CI, 2.12-10.03). Conclusion: Palliative care involvement is associated with increased performance of EOL process measures in patients with breast cancer with LMD.

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

Abstract: Background Documentation of advance care planning for patients with terminal cancer is known to be poor.

Cited by 15 publications

References 19 publications

Implementing ‘Goals of Care’ discussion and palliative care referral for patients with advanced lung cancer: an outpatient‐based pilot project

Implementing ‘Goals of Care’ discussion and palliative care referral for patients with advanced lung cancer: an outpatient‐based pilot project

Documenting Goals of Care Among Patients With Advanced Cancer: Results of a Quality Improvement Initiative

Natural Language Processing to Assess Palliative Care and End-of-Life Process Measures in Patients With Breast Cancer With Leptomeningeal Disease

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