Documenting goals of care (GOC) and prognosis of patients with advanced cancer: A tertiary cancer centre review of internal and external correspondence.

Abstract

e21512 Background: Patients with advanced cancer require clear communication and documentation of GOC and prognosis to inform optimal care planning between the patient, family, specialist and primary healthcare providers. Such documentation may be lacking despite multiple inpatient and outpatient (OP) interactions prior to death. We aimed to review the frequency, content and timing of GOC/prognosis documentation during the last year of life of advanced cancer patients. Methods: All patients who died during palliative care admission at our tertiary centre in 2015 were identified. Patients with incurable solid cancer and reviewed ≥1 times in oncology OP clinic were included. We reviewed all oncology OP consultation notes and letters, oncology discharge summaries and advanced care plans (ACP) over a 12 month period before death. Both internal (OP notes) and external documents (OP letters; discharge summaries) were reviewed in detail for documentation of GOC and prognosis (qualitative/quantitative description). Results: 147 patients were included in the analysis. There was a median of 6 OP consultations and 6 hospital encounters (including admissions) per patient. Median time from first OP consultation to death was 7.7 months. Most patients had documentation of GOC in OP notes (61%) however only 24% had prognosis documented. 63% of OP visits resulted in a letter to external doctors. 58% of patients had ≥1 OP letter documenting GOC (median time before death, 3.9 months) and 16% had a letter documenting prognosis (median time before death, 2.8 months). 73% of patients had a ward admission yet 5% of discharge summaries specified prognosis. Only 15% of patients had an accessible ACP on record. Conclusions: We observed a lack of documentation of GOC and particularly prognosis in internal and external hospital correspondence despite multiple interactions prior to patient death. Although discussion of GOC and prognosis may occur within a consultation, lack of documentation in correspondence reduces insight into patient clinical trajectory and may result in differing care between providers. There is a need for improved communication and documentation in advanced cancer care.