Implementation of standardized electronic documentation of goals of care discussions to improve cancer care.

Abstract

11127 Background: Early documentation of physician-led goals of care (GOC) discussions is important to providing comprehensive and individualized quality care to cancer patients as it can provide all members of the patient care team with a context for the type of care each patient wishes to receive prior to and at end of life. The electronic medical record (EMR) should provide easy access to these conversations to seamlessly integrate outpatient, emergency room and inpatient care of cancer patients. Methods: The institution-wide initiative was introduced via presentations and emails between 8/2021 and 11/2021 to all Moores Cancer Center faculty at UC San Diego Health. A SmartPhrase was created in our EMR Epic as the intervention, including critical components of a GOC discussion: people present during discussion, goal of cancer-directed treatment, anticipated cancer trajectory shared with the patient, and patient’s health care agent. The SmartPhrase was radiolabeled to be easily searchable for any clinician accessing the patient’s chart. Physician documentation was tracked for the purposes of achieving a group goal with a target of greater than 50% documentation of GOC discussions within 30 days of the first day of the first cycle of chemotherapy. Prior to physician education, 4% of patients had a GOC note using a searchable SmartPhrase. In 12/2021, we began sending individual emails to physicians to remind them of eligible patients. Results: By 1/2022, after education, 50% of physicians ordering chemotherapy had used the GOC SmartPhrase and 29% of patients initiating chemotherapy had a GOC note using the SmartPhrase. After initiation of monthly reminder emails, documentation increased to 51% by 10/2022. An increased use of Advanced Care Planning billing codes was also noted. Conclusions: Implementation of an initiative to standardize electronic documentation of GOC conversations improved early documentation of these vital conversations. Radiolabeling of the SmartPhrase made it easily accessible to all members of a patient’s care team.