Science of quality: Communication, decision making, and behavior.

Abstract

22 Background: Addressing advance care planning (ACP) early in metastatic disease is a challenge for providers across oncology. Providing a systematic method to engage providers and patients in these discussions offers opportunities to improve end of life outcomes, improve patient quality of life and engage in shared decision making that supports effective transition to appropriate palliative care and hospice. Methods: A multidisciplinary group of oncology providers developed a framework for ACP which included defining a target population for early introduction, utilizing a standard patient-centered measurement tool (Values Assessment), reviewing practice workflow to schedule ACP conversations, and incorporating documentation elements embedded in the electronic health record. The model included physician referral of patients to a nurse practitioner or social worker who scheduled meetings with patients to assess values, assist patients with advance directives (AD), and explore patient end-of-life wishes based on disease. Seven cancer center sites of service engaged in the pilot study for a 90-day period to test tools, workflow and effectiveness of implementation methods. Documented values assessments, code status, and advance directives were pilot outcomes measures. Results: All sites in the pilot study implemented the framework and participated for 90 days. Workflows were validated to support scheduling of ACP conversations. Use of the values assessment tool was slow to be incorporated in ACP process as was physician referral for introduction. Conclusions: Engaging in a systematic approach to gather and assimilate information provides an opportunity to comparatively assess adoption of an ACP program. Providers are not inherently experienced in basic ACP introduction or deeper ACP discussions. Communications training, including conversations for values assessment and ACP, is in development for use with pilot and new practices engaging in the program, which supports program scalability. [Table: see text]