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Abstract Details

Serious Illness Conversation Documentation in High-grade Glioma
Neuro-oncology
P3 - Poster Session 3 (5:00 PM-6:00 PM)
6-005

(1) Examine content, comprehensiveness, and timing of documented serious illness conversations (SIC) among older adults with high-grade glioma (HGG); and (2) compare comprehensiveness of documentation among patients who did or did not receive palliative care consultation.
Longitudinal SIC in oncology helps ensure care plans align with cancer patients’ goals. High-quality SIC is particularly important for older adults with HGG, given poor prognosis and prevalent cognitive deficits affecting decision-making capacity. 

We retrospectively identified HGG patients aged ≥65 years at diagnosis from an academic health system cancer registry (8/3/2011-1/23/2020) and applied a chart abstraction tool to abstract SIC documentation from their clinical records. Content: We coded text to identify documentation about (1) prognostication; (2) goals of care; and (3) end-of-life care planning. Comprehensiveness: Using 16 possible subtopics, we calculated a summary score (range 0-16). Timing: We identified the first occurrence of documentation across disease phases: (1) diagnostic (pre-chemoradiation); (2) first-line treatment; (3) second-line treatment; and 4) end of life (after cancer-directed treatment).  Using linear regression, we evaluated associations between receipt of palliative care and SIC summary score.
Among 158 older adults, 106 (67%) had any documented SIC: 89 (56%) on prognostication; 86 (54%) on goals of care; and 79 (50%) on end-of-life care. Median SIC score was 7 [interquartile range 3, 12]. First SIC documentation mostly occurred in the diagnostic [n=63 (40%)] or end-of-life phases [n=25 (16%)], but rarely (<10%) in either cancer-directed treatment phase. In linear regression models adjusted for Charlson Comorbidity Index, palliative care consultation was significantly associated with higher SIC score (β=7.0, p<.01).
SIC documentation was limited in scope, with each of the core topics being undocumented for a substantial percentage of this HGG cohort. For half of the cohort, SIC was first documented in the end-of-life phase or was never documented. Palliative care referral may improve SIC quality. 
Authors/Disclosures
Caroline Crooms, MD, MPH (Mount Sinai Hospital)
PRESENTER 		Dr. Crooms has nothing to disclose.
Sara Zalcgendler, MD Dr. Zalcgendler 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.
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.
Laura Gelfman, MD The institution of Dr. Gelfman has received research support from NINR. The institution of Dr. Gelfman has received research support from NIA.
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.