Defining and implementing meaningful advance care planning.

Abstract

e18708 Background: Advance Care Plans (ACP) capture a patient’s preferences for care before the patient becomes unable to make their own decisions. Our center (SKCC) participates in external quality programs, including the ASCO Oncology Medical Home model and CMS’ Oncology Care Model, that require ACP among cancer patients. Evidence from other centers suggest ACP, as defined by these external programs, do not impact patient outcomes. In an effort to increase the rate of “meaningful” ACP our interdisciplinary team completed an iterative quality improvement (QI) project to define an internal, more rigorous standard of ACP. Methods: Clinicians at SKCC developed a standardized Personalized Care Discussion (PCD) appointment conversation template to guide meaningful, goals-based care discussions with cancer patients. Our project assessed the rate at which different patients completed a scheduled PCD appointment between 6/2/2021 and 7/1/2022. The objectives of our QI project were to: identify a sub-population of cancer patients with the highest expected value from PCD; and define an evidence-based metric to hold care teams accountable for completing PCD. Our interdisciplinary QI project team monitored and evaluated 5 cycles of plan-do-study-act (PDSA) over the course of 1 year to meet the project objectives. Each PDSA included either an adjustment to the patient population or an adjustment to the workflow. The key performance indicator in each PDSA was the % of patients with a scheduled PCD appointment who completed the appointment. Results: Of the all the PDSA cycles, the ones with the highest completion rate of a scheduled PCD appointment were cycles in which: the patient’s oncologist introduced the patient to PCD (as opposed to automated scheduling); and the patient was introduced to PCD early on in their care at SKCC. Conclusions: The results of this project led us to develop an internal quality metric that requires oncology providers (OP) facilitate PCD with all new cancer patients within 9 months of the new patient visit. This metric exceeds expectations of external programs by requiring OPs complete goals-based ACP with patients and introducing ACP as a universal standard of cancer care for all new patients. Operational support for OPs is critical for success in this initiative. Patient education that manages sensitivities and stigma about ACP enhances successful OP-patient collaboration. SKCC continues to monitor the impact of this metric on patient outcomes. [Table: see text]