Abstract Details

Title Advance Care Planning Documentation in High-grade Glioma

Topic Palliative Care

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-010

Objective Analyze relationships between receipt of specialty palliative care (SPC) and advance care planning (ACP) among older adults with high-grade glioma (HGG).

Background Low rates of SPC referral and ACP have been documented in HGG. Advanced age is a poor prognostic factor in HGG, making ACP documentation vital in older adults.

Design/Methods Adults >65 with WHO grade 3 or 4 gliomas and at least one neuro-oncology note were identified retrospectively from an academic health system cancer registry (8/3/2011-1/23/2020). A chart abstraction tool operationalizing National Quality Forum Preferred Practices for Palliative Care was applied to all clinician notes, abstracting note-writer specialty and ACP indicators: discussions of care goals, code status, and hospice. Advance directive presence/absence in each chart was also recorded. To analyze relationships between receipt of SPC and ACP documentation, patients were stratified as SPC or non-SPC and compared on ACP indicators and advance directive completion (Fisher exact test). In the SPC group, we explored odds of documentation by SPC relative to neuro-oncology (McNemar’s test).

Results Across 106 patients, ACP documentation frequency by any clinician (neuro-oncologist or SPC) was: goals of care=61.3%, code status=48.1%, hospice=55.7%. Comparing SPC (n=49, 45.8%) and non-SPC groups, more SPC patients had documented goals discussions [83.7% vs 42.1%; p<.01], code status [85.7% vs 15.8%; p<.01], and hospice discussions [81.6% vs 33.3%; p<.01]. The SPC group also had more healthcare proxies [44% vs 7.5%; p<.01] and/or other advance directive [46% vs .5%; p<.01]. Within the SPC group, SPC was more likely than neuro-oncology to have documented goals (odds ratio (OR) 3; [95% CI 1.6, 30.8] or hospice discussions (OR 7; 95% CI [1.1, 8.3]. Code status documentation by neuro-oncology was insufficient to calculate OR.

Conclusions ACP documentation and advance directive completion were more common in patients receiving SPC. However, each indicator was undocumented by either specialty for a meaningful proportion of patients.

Authors/Disclosures
Caroline Crooms, MD, MPH (Mount Sinai Hospital) PRESENTER	Dr. Crooms has nothing to disclose.
Karen Connor	Karen Connor has received personal compensation in the range of $5,000-$9,999 for serving as a Research Consultant with Mount Sinai.
Rachelle Hornick (The Mount Sinai Hospital)	No disclosure on file
Parul Agarwal	Parul Agarwal has nothing to disclose.
Jennie W. Taylor, MD (University of California, San Francisco)	Dr. Taylor has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Servier. The institution of Dr. Taylor has received research support from BMS. The institution of Dr. Taylor has received research support from Servier. The institution of Dr. Taylor has received research support from Navio. Dr. Taylor has received research support from University of Colorado. Dr. Taylor has received research support from Mt Sinai University . Dr. Taylor has received publishing royalties from a publication relating to health care.
Nathan Goldstein	No disclosure on file
Barbara G. Vickrey, MD, MPH, FAAN	The institution of Dr. Vickrey has received research support from NIH. Dr. Vickrey has received personal compensation in the range of $0-$499 for serving as a Grant reviewer, committee co-chair with NIH. Dr. Vickrey has received personal compensation in the range of $0-$499 for serving as a conference advisory committee with University of Rochester. Dr. Vickrey has a non-compensated relationship as a Second Vice President with Association of University Professors of Neurology that is relevant to AAN interests or activities. Dr. Vickrey has a non-compensated relationship as a Nominating Committee member of Stroke Council with American Heart Association that is relevant to AAN interests or activities. Dr. Vickrey has a non-compensated relationship as a Nominating Committee Chair with American Neurological Association that is relevant to AAN interests or activities.

��ɫ��

��ɫ��