Structured Early Advanced Care Planning Outcomes for Patients with High Grade Glioma (S17.006)

Abstract

<h3>Objective:</h3> To assess the impact of integrating structured early advanced care planning (SEACP) into care for patients with malignant glioma (MG). <h3>Background:</h3> SEACP is under-utilized in cancer and critical in MG due to prognosis, progressive cognitive impairment and patient autonomy. <h3>Design/Methods:</h3> Providers underwent training and used checklists to conduct SEACP visits that included patients and caregivers. We performed an IRB-approved retrospective analysis of 40 SEACP visits over 2 years. We reviewed documentation of SEACP and evaluated impact on adherence to end-of-life quality measures (EOLQM) and advanced care planning (ACP) documentation. Chi-square and t-tests were used to compare outcomes to a published pre-SEACP cohort from our institution. Qualitative data regarding patient and provider experience was analyzed using thematic content analysis. <h3>Results:</h3> All SEACP visits were conducted by advanced practice providers or registered nurses. 54% were tele-visits. Topics discussed included: existential concerns (85%), ACP documents (81%), clinical concerns (77%), and patient values (74%). Patients who completed SEACP (n=40) were more likely to have ACP documented than patients in pre-SEACP cohort (85% vs. 44%; p&lt;0.05), to have completed ACP documents themselves rather than by a proxy (81% vs. 55.0%; p&lt;.01) and higher hospice enrollment &gt; 7 days before death (89% vs. 70.0%; p&lt;.05). Evaluation of qualitative data revealed that 100% of patients found SEACP to be helpful in decision making. 75% of caregivers agreed that “I understand my loved one’s illness better after this visit” and 100% of providers agreed SEACP “improved understanding of patient wishes.” <h3>Conclusions:</h3> Our findings suggest that SEACP is effectively performed by non-physician providers and by telemedicine. SEACP improved ACP documentation, patient involvement in ACP decisions and EOLQM while creating a forum to discuss end of life concerns. Patients, caregivers and providers all viewed SEACP positively. <b>Disclosure:</b> Mrs. Pescatello has nothing to disclose. Dr. Mohile has nothing to disclose. Ms. Serventi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Novocure. Mrs. Sayers has nothing to disclose. Mrs. Behr has nothing to disclose. Dr. Hemminger has nothing to disclose. Dr. Hardy has received research support from Del Monte Institute for Neuroscience.