Improving goal concordant care clinician workshops: Do patients benefit?

Abstract

9035 Background: From 2020-2023, the Alliance of Dedicated Cancer Centers (ADCC) undertook a national initiative to improve goal concordant care (IGCC) where all cancer patients and their families receive care that aligns with their values and priorities. One of the core components of the program was to implement a formal communications skills training program supporting the delivery of goal concordant care. As an ADCC member, City of Hope’s (COH) Department of Supportive Care Medicine created the Improving Goal Concordant Care Virtual Workshop Series to address this need. Methods: The 2-part workshop series covered: Goal concordant care, having difficult conversations, advanced care planning (ACP), advance directives, Physician Orders for Life Sustaining Treatment forms, and code status. Physicians and nurse practitioners (NPs) were independently evaluated regarding their quality of care pre-/post workshop #1 by their outpatients through the “Heard and Understood (HAU)” survey, a patient-reported quality measure with 4 items: I felt heard and understood (HU), Provider understood what was important my life (UL), Provider saw me as a person (SP), Provider put my best interests first (BI). Response categories ranged from 1, not at all trueto 5, completely true. Top-box rates and percentage of patients responding completely true for a given item were calculated for each clinician. Pre-/post changes in top-box rates were examined with paired t-tests. Differences in rates over time, by clinician type, were evaluated using mixed effect modeling. Survey items were initially analyzed individually, then combined. A p-value < 0.05 was considered statistically significant. Results: A total of 37 clinicians (26 Physicians and 11 NPs) were evaluated. Patients’ experience with physicians (NPs excluded) improved between pre/post training: The rates increased for the overall HAU scale (4.31, p=0.002), as well as for several individual items such as HU, UL and BI (5.24, 6.33 and 2.52 respectively, p-values<0.05). Notably, the rates for HU increased for physicians but not for NPs (5.24 vs -3.22, difference= 8.46, p=0.012), though NPs had a higher top-box rate at baseline compared to physicians (90.74 vs 78.04, p<0.001). Between group rate differences were not significant for the overall HAU scale over time. Conclusions: Patients’ experience with hematology and oncology physicians improved after physicians received IGCC communication skills training. Moreover, the patients’ experience with NPs was rated higher than physicians before training, but there were no significant differences after training. To further improve physician-patient communication regarding ACP and goal concordant care, the program will adapt and expand to additional departments throughout the COH clinical network.