An Integrated Approach to Selecting a Prepared Medical Decision-Maker

Area of Science:

• Oncology
• Palliative Care
• Health Services Research

Background:

• Engaging cancer outpatients in selecting and preparing a medical decision-maker is crucial for advance care planning.
• A systematic multidisciplinary process was implemented to facilitate this engagement.

Purpose of the Study:

• To evaluate the effectiveness of a systematic multidisciplinary process in engaging new cancer outpatients in preparing a medical decision-maker.
• To assess the documentation of advance care planning (ACP) and medical power of attorney (MPOA) within the electronic health record (EHR).

Main Methods:

• A multidisciplinary team utilized templated ACP notes and MPOA documents in the EHR by the third office visit.
• Patients received coaching to meet with social work, viewed educational videos in English or Spanish, and used simplified explanations of advance directives.

Main Results:

• Out of 351 evaluated patients, no increase in documented social work ACP notes or scanned MPOA documents was observed by the third visit.
• The implemented systematic multidisciplinary approach did not significantly enhance patient engagement in preparing a medical decision-maker.

Conclusions:

• The systematic multidisciplinary approach, as implemented, was insufficient to engage cancer outpatients in preparing a medical decision-maker.
• Future interventions require more active physician involvement and diverse engagement strategies to improve advance care planning documentation.