Selecting a prepared medical decision maker.

Abstract

18 Background: Selection and preparation of a medical decision maker (MDM) is key to person-centered advance care planning (ACP). ASCO’s Quality Practice Oncology Initiative recommends that all new patients (pts) discuss advance directives or ACP by the third office visit (OV). Methods: We collected baseline data from 9/8/16-12/31/16 for all new pts presenting with invasive malignancy to 4 gynecologic oncologists. A patient needs survey (PNS) was conducted at the 1st OV to evaluate if pts had completed a medical power of attorney (MPOA) & pt desire for additional assistance with advance directives (AD) or ACP. Electronic health records (EHR) were reviewed for the 1st 3 OV to determine disease status, presence of scanned MPOA and nature and type of ACP notes, including documentation of MD/advance practice provider (MD/APP) discussion of MPOA, social work (SW) MPOA counseling & elements suggesting selection of a prepared MDM. Pearson Chi-Square or Mann-Whitney U test were used for comparisons, as appropriate. Results: Of 150 women, disease status was available for 133 (91%). Data presented are for pts with known status. Median (range) number of visits was 2 (1-3). 29% reported having an AD, but only 11% had a MPOA in the EHR. (See Table). Conclusions: Our data suggest that current processes do not successfully capture the majority of already completed MPOA, most pts do not perceive the relevance of selecting a prepared MDM and that most named MDMs have not been well prepared. Other than for visit #, there were no significant differences by disease status. Future QI cycles will focus on more active pt engagement. [Table: see text]