Patients with advanced cancer want and need to partner with their care team to make treatment decisions that reflect their own values and align with what matters most.
“Serious illness conversations” include two equally important parts: clinicians sharing information on prognosis and treatment options, and patients and their loved ones sharing their values and preferences.
Despite professional guidelines recommending early serious illness conversations for all patients with advanced cancer, many times these conversations occur, unfortunately, late or not at all.
As the first part of a larger initiative across Dartmouth Cancer Center, a broad team of clinician-researchers, clinical partners, data scientists and even a patient partner have implemented a quality improvement project that was able to increase the occurrence and documentation of these important conversations in two disease-specific medical oncology clinics.
Over the 18-month study period, the teams increased their baseline documentation rate from 0% to 70%, or 43 of 63 eligible patients.
Results of the project, “Interdisciplinary Approach and Patient/Family Partners to Improve Serious Illness Conversations in Outpatient Oncology,” are newly published in JCO Oncology Practice, an American Society of Clinical Oncology journal.
“We partnered with our colleagues in Palliative Care, who provided an evidence-based training program to increase our knowledge, skills and comfort in leading serious illness conversations,” says lead author Garrett T. Wasp, MD, a medical oncologist in Dartmouth Cancer Center’s Head & Neck Cancer Program.
The group identified four drivers for their success: standardised work, an engaged interdisciplinary team, engaged patients and families, and system-level support.
With the help of Dartmouth Health’s technology team, clinicians succeeded in documenting serious illness conversations in a standardised, one-page format that was easily accessible in the electronic medical record.
The work also inspired creation of clinician-facing tools that allow for automated tracking and reporting of serious illness conversations.
Source: Dartmouth Cancer Center