Serious Illness Communication Practices in Glioblastoma: An Institutional Perspective

Area of Science:

• Oncology
• Palliative Care
• Medical Ethics

Background:

• Effective advance care planning (ACP) is vital for goal-concordant care in glioblastoma (GBM) patients.
• Serious illness (SI) communication practices require thorough evaluation to ensure patient needs are met.

Purpose of the Study:

• To characterize current SI communication practices for GBM patients at a specific institution.
• To assess the association between SI conversations and patient outcomes.

Main Methods:

• Mixed-methods approach combining retrospective electronic medical record review of 240 deceased GBM patients and qualitative interviews with five clinicians.
• Analysis of documented SI conversations (prognosis, goals, end-of-life, code status) and patient outcomes.
• Grounded-theory coding of clinician interview transcripts to identify emergent themes.

Main Results:

• High documentation rates (96%) of SI conversations, with a median of 4 conversations per patient, primarily with medical oncologists.
• First SI conversations occurred a median of 360 days before death, but were not significantly associated with improved patient outcomes.
• Clinician interviews revealed themes of balancing hope, need for earlier and coordinated conversations, and communication training gaps, contrasting with documentation data.

Conclusions:

• While SI conversations are frequently documented early for GBM patients, their quality and impact on goal-concordant care are difficult to assess.
• Clinicians perceive SI conversations as often late, infrequent, and fragmented, indicating a disconnect between documentation and perceived quality of care.
• There is a critical need to enhance the quality, coordination, and comprehensiveness of SI communication for GBM patients to truly support goal-concordant care.