Goals of Care Rapid Response Team at a Comprehensive Cancer Center: Feasibility and Preliminary Outcomes (S537)

Abstract

Outcomes1. Describe an approach to supporting goal-concordant care for critically ill hospitalized patients with cancer2. Identify areas for improvement in the Goals of Care Rapid Response Team process3. Discuss potential implications for use in other settingsOriginal Research BackgroundThe COVID-19 pandemic placed the issue of resource utilization front and center. Our comprehensive cancer center developed a Goals of Care Rapid Response Team (GOCRRT) to optimize resource utilization with goal-concordant patient care.Research Objectives1. Evaluate feasibility of GOCRRT by number of consultations that occurred for referred patients.2. Describe adherence to GOCRRT processes: core team member participation (clinical ethics, medical oncology, supportive care, and social work) and advance care planning (ACP) template use for easily retrievable documentation.3. Explore preliminary efficacy of GOCRRT consultations in limiting goal-concordant care escalation (change of resuscitation status to DNR, location change from ICU to regular nursing unit, or withdrawal of life-sustaining treatment).MethodsWe conducted a retrospective chart review of patients referred to GOCRRT from 3/23/2020 to 9/30/2020. Analysis was descriptive. Categorical variables were compared with Fisher's exact or chi-square tests and continuous variables with Mann-Whitney U tests.ResultsEighty-nine patients were referred. 76 (85%) underwent a total of 95 consultations. Mean (SD) patient age was 60 (14) years, 54% male, 19% Hispanic, 48% White, 72% married, and 66% of Christian faith traditions. There were slightly more hematologic malignancies than solid (53% vs 47%). The majority (77%) had metastatic disease or relapsed leukemia. 7% had confirmed COVID-19 at referral. 69% expired during the index hospitalization. There was no statistically significant difference in demographic or clinical characteristics between groups (no consultation, 1 consultation, >1 consultation). All core team members were present at 64% of consultations. Consultations were documented in ACP templates in 33%. Care de-escalation occurred in 45% of patients.ConclusionGOCRRT consultations are feasible and associated with care de-escalation. Adherence to core team participation was good, but documentation in ACP templates was uncommon.Implications for Research, Policy, or PracticeResearch to confirm efficacy and components critical to success and to evaluate outcomes in different patient populations and care settings is needed.