Electronic prompt to improve outpatient code status documentation for advanced lung cancer.

Abstract

6048 Background: Rates of documentation of end-of-life care preferences in the medical record remain low, even among patients with incurable malignancies. The goal of this study was to assess the impact of electronic prompts to encourage oncology clinicians to document code status in the outpatient electronic health record (EHR) of patients with advanced lung cancers. Methods: We conducted two clinician focus groups (n=15) at an affiliated academic medical center to determine the appropriate content and timing of the electronic reminders. Based on the focus groups, we developed email reminders that were timed to the start of each new chemotherapy regimen. Between 6/09 and 1/11, 102 eligible patients with advanced lung cancer were approached, and 100 (98%) agreed to participate in the prospective study. Email reminders were sent to oncology clinicians at the patient's next outpatient visit and with each new chemotherapy regimen. Using a pre-post design, we compared study participants to a retrospective cohort of 100 consecutive historical controls who began chemotherapy for advanced lung cancer at least one year prior to the start of this study. The primary outcome measure was the documentation of code status in the EHR. Results: Study participants were similar to historical controls, with no significant differences in age, gender, performance status, histology or initial cancer therapy received. At one year follow-up, 33/98 (34%) of participants had a code status documented in the outpatient EHR compared with 12/83 (15%) of historical controls, p=0.003. Mean time to code status documentation was significantly shorter in study participants (8.6 months [95% CI 7.6-9.5]) compared with controls (10.5 months [95% CI 9.8-11.3]), p=0.004. Conclusions: Email prompts triggered by changes in chemotherapy improved the rate and timing of code status documentation in the EHR.