Advance Care Planning in Patients With Metastatic Cancer: A Quality Improvement Initiative

Area of Science:

• Oncology
• Palliative Care
• Healthcare Management

Background:

• Advance care planning (ACP) is crucial for goal-concordant care in metastatic cancer patients.
• Initiatives are needed to improve ACP engagement in this population.

Purpose of the Study:

• To increase the rate of advance care planning (ACP) activities among outpatients with metastatic cancer.
• To evaluate the impact of an embedded Palliative Medicine (PM) consultation strategy on ACP.

Main Methods:

• Patients with metastatic cancer identified via ICD-10 codes and EHR documentation.
• ACP activities included ACP notes, Advance Directives, POLST, or PM consultations within one year.
• Intervention involved embedded PM consultants, quarterly comparative reports for oncologists, and patient lists for those without ACP.

Main Results:

• ACP activities increased from 37% to 57% between July 2017 and December 2020.
• Palliative Medicine consultations rose from 12% to 39%; ACP notes increased from 16% to 29%.
• No significant change observed in Advance Directive or POLST completion rates.

Conclusions:

• The initiative effectively increased ACP activities for metastatic cancer patients, primarily through Palliative Medicine referrals.
• Sustained progress requires enhancing oncology care teams' ACP skills and motivation.
• Further strategies are needed to improve Advance Directive and POLST completion rates.