Standardizing goals of care (GoC) documentation for new patients with metastatic disease.

Abstract

26 Background: Executing GoC discussions is an established national standard, underpins high quality patient-centered cancer care and ensures that patients participate actively in treatment decision-making. Capturing key aspects of those discussions in electronic documentation can be challenging when provider time is limited. This project sought to standardize workflow components to enable provider capacity to meet a GoC standard that ≥75% of patients presenting with metastatic cancer have a GoC discussion by their third visit as evidenced by retrievable documentation (EMR format and location). Methods: Baseline data describing provider: patient GoC interactions with eligible patients was obtained and presented. Providers reached consensus on a consistent timing, location and content for electronic GoC documentation. Patient assessment parameters for identifying patients needing GoC discussions were generated, a procedure outlining documentation expectations and facilitative tools were developed. Clinicians were educated on their roles in the process. A variety of quality improvement tools were utilized in project execution (e.g. focus groups, process mapping, cause-effect diagraming, pareto and control charting). Results: See table. Conclusions: Despite time constraints in a busy practice, the ≥75% target set for retrievable GoC documentation was exceeded within the 9-month project timeframe. Providers improved their documentation with familiarity and experience over time. Compliance with documentation location and use of smart phrases were not fully realized, likely due to the short timeframe for adoption of all elements of project aims. Continued improvement is expected as providers become more comfortable with the process and additional facilitative strategies are further integrated including expanding nursing assessment of patients' GoC needs, dedicating time in scheduling templates, Epic alert builds and utilizing Palliative Care Team assist for patients deemed uncomfortable with GoC discussions.[Table: see text]