Capturing patient advance directives status in a community oncology practice using an electronic patient-reported outcomes (ePRO) system.

Abstract

5 Background: The American Society of Clinical Oncology recommends that providers encourage early advance care planning with their patients; yet, many cancer patients do not have advance directives (ADs). A potential reason for low AD rates is inadequate communication between the provider and patient. To address this gap, we developed an outpatient clinic AD initiative for any stage cancer patients via an ePRO system. The AD module was designed to ensure patients are aware of ADs and to assess whether or not the patient had ADs, specifically a Living Will and/or a durable power of attorney and their interest in receiving information about ADs. The study purpose was to assess patient AD status at the patient’s initial visit to an oncology clinic. Methods: This study used a retrospective, observational design that involved use of PRO data collected via the Patient Care Monitor (PCM), a web-based ePRO system linked to electronic medical record data. All study data were collected as part of routine clinical care. All patients at an initial visit to an oncology clinic completed the PCM survey, including the AD module, via a handheld e-tablet. Results: Overall, 18,239 patients completed the AD module (mean age 62; 32% male/68% female; 55% married; 60% White, 36% Black). One third of all patients (30%) reported having an AD at the time of the initial visit to the oncology clinic, specifically 11% indicated having a Living Will and 19% a durable power of attorney. The remaining two-thirds (70%) indicated either NOT having an AD (58%) or not knowing if they had an AD (12%). Patients with ADs were more likely to be older (M= 69 v. 59 yrs) and White (77% v 20% Black) ps < .0001. Of the patients without ADs, 10% requested more information on ADs. These patients were more likely to be older (M= 61 v. 58 yrs), female (68% v 32%), Black (54% v 40% White) and non-married/non-partnered (53% v 47%); ps < .005. Conclusions: This study demonstrates that the majority of patients do not have ADs at the time of an initial visit to a community-based oncology practice. Using an ePRO system can be an innovative and non-threatening way to identify unmet needs of patients and link them to resources for developing advance directives.