Using Oncology Treatment Pathway Data to Evaluate Serious Illness Communication, Care Utilization, and End-of-Life Care for Patients With Cancer.

Abstract

Oncology treatment pathways provide decision support and encourage guideline adherence. Pathway data combined with electronic health record (EHR) data can identify patient populations with poor prognoses, low serious illness conversation (SIC) rates, and high acute care utilization that may benefit from targeted interventions. We conducted a retrospective cohort analysis among adults with cancer treated at seven affiliated sites of the Dana-Farber Cancer Institute (DFCI) who had navigations within 21 treatment pathways between July 29, 2019, and March 8, 2023. DFCI clinicians previously identified pathway nodes with an estimated survival less than 1 year, termed poor prognosis (PP) nodes. We combined pathway data with EHR data to calculate the median overall survival (OS) and proportion of patients with SICs, acute care utilization (hospitalizations and emergency department visits), and outpatient palliative care 6 months after treatment node navigation for all, PP, and nonpoor prognosis (nPP) nodes. SICs were identified using the EHR advanced care planning (ACP) tab. There were 15,261 navigations for 10,203 patients (median age 66 years, 55% female, 85% White). The median OS was 13.8 months for all nodes, 7.8 months for PP nodes, and 21.0 months for nPP nodes. The ACP section of the EHR rate 6 months after navigation was 19.6% for PP nodes versus 11.0% for nPP nodes. There was substantial intragroup variability in OS and SIC rates among all nodes. SICs were recorded in the ACP tab for only 34.3% of decedents. Patients who navigated to PP nodes had higher levels of acute care utilization and palliative care encounters. Treatment pathway data enabled identification of patient populations with poor prognoses, low SIC rates, and high acute care utilization.