Abstract Details

Title Structured Early Advanced Care Planning Outcomes for Patients with High Grade Glioma

Topic Neuro-oncology

Presentation(s) S17 - Innovations in Neuro-oncology (2:00 PM-2:12 PM)

Poster/Presentation
Number 006

Objective To assess the impact of integrating structured early advanced care planning (SEACP) into care for patients with malignant glioma (MG).

Background SEACP is under-utilized in cancer and critical in MG due to prognosis, progressive cognitive impairment and patient autonomy.

Design/Methods 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.

Results 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<0.05), to have completed ACP documents themselves rather than by a proxy (81% vs. 55.0%; p<.01) and higher hospice enrollment > 7 days before death (89% vs. 70.0%; p<.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.”

Conclusions

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.

Authors/Disclosures
Meredith Pescatello (University of Rochester) PRESENTER	Mrs. Pescatello has nothing to disclose.
Nimish A. Mohile, MD, FAAN	The institution of Dr. Mohile has received research support from Novocure.
Jennifer N. Serventi, PA (University Of Rochester Medical Center)	Ms. Serventi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Novocure.
	No disclosure on file
Jacqueline M. Behr, NP (University of Rochester Medical Center)	Mrs. Behr has nothing to disclose.
Lauryn Hemminger (Strong Memorial Hospital)	Dr. Hemminger has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion.
Sara Hardy, MD (University of Washington)	Dr. Hardy has received research support from the American Cancer Society.

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