Abstract Details

Title Early START: A Prospective Study of Early Advanced Care Planning by Telehealth in Glioblastoma

Topic Palliative Care

Presentation(s) P3 - Poster Session 3 (11:45 AM-12:45 PM)

Poster/Presentation
Number 11-002

Objective

To evaluate the feasibility and preliminary efficacy of a prospective Early Structured Advanced Care Planning by Telehealth (Early START) for patients with glioblastoma (pGBM) and their care partners (CP).

Background

Previous work demonstrated that pGBM have delayed advanced directive (AD) documentation and half of AD were completed by proxy due to early cognitive decline. We developed an innovative early advanced care planning (ACP) intervention. Preliminary retrospective data found improved AD completion with more pGBM completing their own AD (81% vs. 55%; p<0.01) compared to historical controls.

Design/Methods Providers underwent training to conduct standardized Early START visits (ESV). pGBM and CP consented for ESV within 4 months of diagnosis, received a pre-visit educational guide to increase ACP literacy, and underwent a provider-led ESV. Post-visit surveys were given to pGBM, CP and providers. ESV content, AD documentation, and end-of-life (EOL) quality measures were collected.

Results 26 pGBM and 47 CP (range 0-6 per patient) completed ESV. Median time from diagnosis to ESV was 2.7 months and all were within 4 months. Average ESV was 66 minutes and 16/26 were completed via telemedicine. 100% of pGBM completed ACP documents within 4 months and none were by proxy (p<0.00001 compared to historical controls). 17/26 ESVs led to documentation of life-sustaining treatments. All providers stated that ESV improved understanding of patient values. 20/21 pGBM noted ESV prepared them for EOL decisions and all reported ESV enhanced autonomy. 21/21 pGBM and 32/33 CP recommend ESV; only 2 pGBM and CP felt the visit was too early. 31/33 CP felt they had improved understanding of their loved one's goals for medical care. Matured data regarding EOL quality measures will be presented.

Conclusions

Early START, an innovative care model of ACP by telehealth, is feasible, enhances early and autonomous ACP and AD documentation, and is highly valued by pGBM, CP, and providers.

Authors/Disclosures
Lauryn Hemminger (Strong Memorial Hospital) PRESENTER	Dr. Hemminger has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion.
Jacqueline M. Behr, NP (University of Rochester Medical Center)	Mrs. Behr has nothing to disclose.
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.
Maxime Jean, MD, PhD (University of Rochester Medical Center)	Dr. Jean has nothing to disclose.
Kathryn Eszes, MD	Dr. Eszes has nothing to disclose.
Sara Hardy, MD (University of Washington)	Dr. Hardy has received research support from the American Cancer Society.
Benzi Kluger, MD, FAAN (University of Rochester)	Dr. Kluger has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for International Neuropalliative Care Society. Dr. Kluger has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Annals of Palliative Medicine. The institution of Dr. Kluger has received research support from NIH. The institution of Dr. Kluger has received research support from PCORI.
Nimish A. Mohile, MD, FAAN	The institution of Dr. Mohile has received research support from Novocure.

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