scholarly journals How Well Do Documented Goals-of-care Discussions for Patients With Stage IV Cancer Reflect Communication Best Practices?

2020 ◽  
Author(s):  
Natalie C. Ernecoff ◽  
Kathryn L. Wessell ◽  
William A. Wood ◽  
Gary S. Winzelberg ◽  
Frances A. Collichio ◽  
...  
Keyword(s):  
Best Practices ◽  
Cancer Progression ◽  
Treatment Options ◽  
Stage Iv ◽  
Treatment Recommendation ◽  
Treatment Preferences ◽  
Goals Of Care ◽  
Patient Goals ◽  
Stage Iv Cancer

Abstract Background: Written clinical communication regarding patients’ disease understanding and values may facilitate goal-concordant care, yet little is known about electronic health record (EHR) goals-of-care documentation. We sought to (1) describe frequency of communication best practices in EHR-documented goals-of-care discussions, and (2) assess whether templated notes improve quality of documentation.Methods: We abstracted all EHR-documented goals-of-care discussions for hospitalized patients with Stage IV cancer from admission to 60-days follow-up. Goals-of-care documentation was operationalized to include discussion of: (1) prognosis or illness understanding; and (2) goals or treatment options. Investigators qualitatively coded text based on conceptual frameworks for communication best practices, and noted if a health system template was used. Results: Among 206 of 492 (42%) patients with documented goals-of-care discussions, clinicians frequently communicated cancer progression or incurability (89%), but rarely addressed prognosis for life expectancy (22%). Goals and values were documented for 83%, and a treatment decision for 82% of patients. Treatment preferences were assessed for 98% of patients; options discussed included cancer treatment (62%), hospice (62%), resuscitation (51%), or intensive care (38%). Clinicians made a treatment recommendation for 40% of patients. Attention to emotional and spiritual concerns was uncommon (15%). Use of a template increased documentation of patient goals and values (80% vs. 61%, p<0.01), but did not enhance other communication best practices.Conclusion: Insights from the study can be used to guide future training and research to study and improve the quality of written communication about goal of care, and its impact on goal-concordant care.

scholarly journals How Well Do Documented Goals-of-Care Discussions for Patients with Stage IV Cancer Reflect Communication Best Practices?

2021 ◽  
Author(s):  
Natalie C. Ernecoff ◽  
Kathryn L. Wessell ◽  
William A. Wood ◽  
Gary S. Winzelberg ◽  
Frances A. Collichio ◽  
...  
Keyword(s):  
Best Practices ◽  
Cancer Progression ◽  
Treatment Options ◽  
Stage Iv ◽  
Treatment Recommendation ◽  
Treatment Preferences ◽  
Goals Of Care ◽  
Patient Goals ◽  
Stage Iv Cancer

Abstract Background: Written clinical communication regarding patients’ disease understanding and values may facilitate goal-concordant care, yet little is known about electronic health record (EHR) goals-of-care documentation. We sought to (1) describe frequency of communication best practices in EHR-documented goals-of-care discussions, and (2) assess whether templated notes improve quality of documentation.Methods: We abstracted all EHR-documented goals-of-care discussions for hospitalized patients with Stage IV cancer from admission to 60-days follow-up. Goals-of-care documentation was operationalized to include discussion of: (a) prognosis and/or illness understanding; and (b) goals and/or treatment options. Investigators qualitatively coded text based on conceptual frameworks for communication best practices, including decision making documentation, and noted if a health system template was used. Results: Among 206 of 492 (42%) patients with documented goals-of-care discussions, clinicians frequently communicated cancer progression or incurability (89%), but rarely addressed prognosis for life expectancy (22%). Goals and values were documented for 83%, and a treatment decision for 82% of patients. Treatment preferences were assessed for 98% of patients; options discussed included cancer treatment (62%), hospice (62%), resuscitation (51%), or intensive care (38%). Clinicians made a treatment recommendation for 40% of patients. Attention to emotional and spiritual concerns was uncommon (15%). Use of a template increased documentation of patient goals and values (80% vs. 61%, p<0.01), but did not enhance other communication best practices.Conclusion: Insights from the study can be used to guide future training and research to study and improve the quality of written communication about goal of care, and its impact on goal-concordant care.

scholarly journals How well do documented goals-of-care discussions for patients with stage IV cancer reflect communication best practices?

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Natalie C. Ernecoff ◽  
Kathryn L. Wessell ◽  
William A. Wood ◽  
Gary S. Winzelberg ◽  
Frances A. Collichio ◽  
...  
Keyword(s):  
Best Practices ◽  
Cancer Progression ◽  
Treatment Options ◽  
Specific Treatment ◽  
Stage Iv ◽  
Treatment Decision ◽  
Free Text ◽  
Goals Of Care ◽  
Stage Iv Cancer

Abstract Background Written clinical communication regarding patients’ disease understanding and values may facilitate goal-concordant care, yet little is known about the quality of electronic health record (EHR) documentation. We sought to (1) describe frequency of communication best practices in EHR-documented goals-of-care discussions, and (2) assess whether templated notes improve quality of documentation. Methods Researchers pulled text of EHR-documented goals-of-care discussions for hospitalized patients with Stage IV cancer from admission to 60-days follow-up. Text was included when in a single encounter the clinician addressed: (a) prognosis and/or illness understanding; and (b) goals and/or treatment options. Researchers qualitatively coded text based on guidelines for communication best practices, and noted if an EHR template was used. Results Forty-two percent (206/492) of patients had EHR-documented goals-of-care discussions. Text frequently described communication of cancer progression (89%), though rarely included prognosis (22%). Text often included patients’ goals and values (83%), and at least on specific treatment decision (82%). Communication about treatments was included for 98% of patients; common examples included cancer treatment (62%), hospice (62%), resuscitation (51%), or intensive care (38%). Clinicians documented making recommendations for 40% of patients. Text addressing patient emotional and spiritual concerns was uncommon (15%). Compared to free text, use of a template was associated with increased documentation of goals and values (80% vs. 61%, p < 0.01), but not other best practices. Conclusion Insights from the study can be used to guide future training and research to study and improve the quality of documentation about goal of care, and its impact on goal-concordant care.

Content of Documented Goals of Care Discussions Based on Communication Best Practices for Patients with Stage IV Cancer (RP306)

2020 ◽  
Vol 60 (1) ◽  
pp. 203
Author(s):  
Laura Hanson ◽  
Natalie Ernecoff ◽  
Kathryn Wessell ◽  
William Wood ◽  
Frances Collichio ◽  
...  
Keyword(s):  
Best Practices ◽  
Stage Iv ◽  
Goals Of Care ◽  
Stage Iv Cancer

Conducting Goals-of-Care Discussions Takes Less Time Than Imagined

2020 ◽  
Vol 16 (12) ◽  
pp. e1499-e1506
Author(s):  
Sofya Pintova ◽  
Ryan Leibrandt ◽  
Cardinale B. Smith ◽  
Kerin B. Adelson ◽  
Jason Gonsky ◽  
...  
Keyword(s):  
Cancer Progression ◽  
High Quality ◽  
Goals Of Care ◽  
Coaching Model ◽  
Face To Face ◽  
Significant Difference ◽  
Encounter Time ◽  
Face Time ◽  
To Receive

PURPOSE: To describe the length of encounter during visits where goals-of-care (GoC) discussions were expected to take place. METHODS: Oncologists from community, academic, municipal, and rural hospitals were randomly assigned to receive a coaching model of communication skills to facilitate GoC discussions with patients with newly diagnosed advanced solid-tumor cancer with a prognosis of < 2 years. Patients were surveyed after the first restaging visit regarding the quality of the GoC discussion on a scale of 0-10 (0 = worst; 10 = best), with ≥ 8 indicating a high-quality GoC discussion. Visits were audiotaped, and total encounter time was measured. RESULTS: The median face-to-face time oncologists spent during a GoC discussion was 15 minutes (range, 10-20 minutes). Among the different hospital types, there was no significant difference in encounter time. There was no difference in the length of the encounter whether a high-quality GoC discussion took place or not (15 v 14 minutes; P = .9). If there was imaging evidence of cancer progression, the median encounter time was 18 minutes compared with 13 minutes for no progression ( P = .03). In a multivariate model, oncologist productivity, patient age, and Medicare coverage affected duration of the encounter. CONCLUSION: Oncologists can complete high-quality GoC discussions in 15 minutes. These data refute the common misperception that discussing such matters with patients with advanced cancer requires significant time.

Management of Malignant Melanoma: Best Practices

2009 ◽  
Vol 13 (2) ◽  
pp. 55-73 ◽  
Author(s):  
Michael Smylie ◽  
Joël Claveau ◽  
Kenneth Alanen ◽  
Raymond Taillefer ◽  
Ralph George ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Best Practices ◽  
Gamma Probe ◽  
Treatment Options ◽  
Stage Iv ◽  
Primary Diagnosis ◽  
Interferon Α ◽  
Node Biopsy ◽  
Stage Iv Disease ◽  
Intraoperative Gamma Probe

Background: Melanoma is a commonly occurring cancer in Canada, with an estimated age-standardized incidence of 10 to 13 per 100,000. An estimated 4,300 new cases were diagnosed, and there were 880 reported deaths in 2005. Objective and Conclusion: The Canadian Expert Panel on Malignant Melanoma has developed best practices to improve the management of malignant melanoma. Sections include recommendations on primary diagnosis, dermatopathologic assessment, and reporting; use of preoperative lymphoscintigraphy and an intraoperative gamma probe to map and biopsy the sentinel lymph node; indications for surgical resection, sentinel node biopsy, and surgery for advanced disease; use of interferon-α adjuvant therapy and treatment options for stage IV disease; and management of central nervous system metastases.

Aggressive care at the end of life: A study of practice based factors in patients with stage IV cancer.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 80-80
Author(s):  
Mohammad Omar Atiq ◽  
Rahul Ravilla ◽  
Ajay Kumar ◽  
Sajjad Haider ◽  
Ji-Ling Tang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
End Of Life ◽  
Cancer Patients ◽  
Stage Iv ◽  
Goals Of Care ◽  
Significant Difference ◽  
Aggressive Care ◽  
Stage Iv Cancer ◽  
End Stage

80 Background: Numerous studies established that early utilization of palliative care-hospice services are beneficial to cancer patients. To reduce the incidence of aggressive care in terminal cancer patients, we conducted a quality improvement study to identify pertinent risk factors and develop interventions. Methods: Through chart review, we retrospectively identified patients with stage IV cancer that were followed by oncology clinic and were admitted to the University Hospital between 8/1/2015-10/31/15. For those patients who died during the last hospitalization or were discharged to hospice care, we obtained demographic, cancer related and practice related variables listed in Table. We used Mann Whitney U test and multivariable regression to find effects of factors related to length of stay (LOS) and cost of stay (COS). Results: Length of stay was significantly prolonged in those receiving chemotherapy within the past month (6 vs 3 p=0.035). Multivariate analyses found that patients with goals of care documented in the clinic had lower COS by 36.7% and LOS by 46.7%. On average, an ICU stay resulted in COS 2.2 times higher. No significant difference was seen in LOS based on a documented palliative care clinic visit or presence of an advanced directive. Conclusions: We identified practice based factors that need improvement including earlier goals of care conversations and less chemotherapy at the end of life. Identifying end stage patients in earlier admissions, collaborating with palliative care, and adding goals of care documentation to clinic note templates, are all interventions we are studying to improve care for end stage cancer patients. [Table: see text]

scholarly journals Management of Vaginal Atrophy: Implications from the REVIVE Survey

2014 ◽  
Vol 8 ◽  
pp. CMRH.S14498 ◽  
Author(s):  
Susan Wysocki ◽  
Sheryl Kingsberg ◽  
Michael Krychman
Keyword(s):  
Unmet Needs ◽  
Medical Condition ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Treatment Preferences ◽  
Vaginal Atrophy ◽  
Vaginal Symptoms ◽  
Poor Understanding ◽  
Women’S Views

Vulvar and vaginal atrophy (VVA) is a chronic and progressive medical condition common in postmenopausal women. Symptoms of VVA such as dyspareunia, vaginal dryness, irritation, and itching can negatively impact sexual function and quality of life. The REVIVE (REal Women's Views of Treatment Options for Menopausal Vaginal ChangEs) survey assessed knowledge about VVA and recorded attitudes about interactions with healthcare providers (HCPs) and available treatment options for VVA. The REVIVE survey identified unmet needs of women with VVA symptoms such as poor understanding of the condition, poor communication with HCPs despite the presence of vaginal symptoms, and concerns about the safety, convenience, and efficacy of available VVA treatments. HCPs can address these unmet needs by proactively identifying patients with VVA and educating them about the condition as well as discussing treatment preferences and available therapies for VVA.

scholarly journals High-capacity poly(2-oxazoline) formulation of TLR 7/8 agonist extends survival in a chemo-insensitive, metastatic model of lung adenocarcinoma

2020 ◽  
Vol 6 (25) ◽  
pp. eaba5542 ◽  
Author(s):  
Natasha Vinod ◽  
Duhyeong Hwang ◽  
Salma H. Azam ◽  
Amanda E. D. Van Swearingen ◽  
Elizabeth Wayne ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Treatment Options ◽  
High Capacity ◽  
Stage Iv ◽  
Inhibitory Effect ◽  
Immune Checkpoint Blockade ◽  
Platinum Based Chemotherapy ◽  
Stage Iv Cancer ◽  
Antigen Presenting

About 40% of patients with non–small cell lung cancer (NSCLC) have stage IV cancer at the time of diagnosis. The only viable treatment options for metastatic disease are systemic chemotherapy and immunotherapy. Nonetheless, chemoresistance remains a major cause of chemotherapy failure. New immunotherapeutic modalities such as anti–PD-1 immune checkpoint blockade have shown promise; however, response to such strategies is highly variable across patients. Here, we show that our unique poly(2-oxazoline)–based nanomicellar formulation (PM) of Resiquimod, an imidazoquinoline Toll-like receptor (TLR) 7/8 agonist, had a superior tumor inhibitory effect in a metastatic model of lung adenocarcinoma, relative to anti–PD-1 therapy or platinum-based chemotherapy. Investigation of the in vivo immune status following Resiquimod PM treatment showed that Resiquimod-based stimulation of antigen-presenting cells in the tumor microenvironment resulted in the mobilization of an antitumor CD8+ immune response. Our study demonstrates the promise of poly(2-oxazoline)-formulated Resiquimod for treating metastatic NSCLC.

My choices, my wishes: Advance care planning advocacy in the adult oncology population.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 6-6
Author(s):  
Sabrina Q. Mikan ◽  
J. Russell Hoverman ◽  
Debra A. Patt ◽  
Brian Turnwald
Keyword(s):  
Stage Iv ◽  
Office Visit ◽  
Care Planning ◽  
Intervention Process ◽  
Before And After ◽  
Oncology Care ◽  
Advance Care ◽  
Stage Iv Cancer ◽  
Eol Care

6 Background: Working through end-of-life care (EOL) issues with our patients is one of the most challenging aspects of cancer care. Although studies of EOL care interventions that are patient-focused and result in high-quality EOL experiences are increasing, most still do not achieve an EOL experience consistent with preferences. We aimed to provide an intervention for standardized advanced care planning (ACP) documentation and education to improve quality of life (QOL) for patients (pts) with terminal cancer (TC). Methods: Pts with TC (for this study defined as stage IV cancer or metastatic disease) were evaluated retrospectively through our EHR IKnowMed (IKM) before and after an ACP documentation and an education intervention. Descriptive statistics were used to identify and measure utilization of ACP introduction and charting as well as completion of advance directive documentation. Within IKM there are discrete fields for EOL data including ACP discussion, ACP facilitation, documentation of ADs. Education on tool documentation occurred in early 2012. Our ACP program was launched in March 2012. This included an ACP office visit conducted by a practitioner with ACP training, standardized education literature on EOL and ACP, launch of a website with EOL and ACP educational material, recording of ACP documents and documentation of hospice utilization and ACP preferences within our EHR. Results: Baseline characteristics and improvements in ACP introduction, charting, and AD documentation that occurred during our documentation and intervention process can be seen in the Table. Conclusions: Implementation of a standardized ACP program improves utilization and documentation of ACP planning, and documentation of ADs. These interventions improve QOL and health literacy for patients with TC. By incorporating these strategies with definable metrics, strategic intervention can be measured and reported. Further study of the relationships between ACP documentation and patient outcomes is necessary for comprehensive oncology care. [Table: see text]

scholarly journals Patient–physician discordance in goals of care for patients with advanced cancer

2019 ◽  
Vol 26 (6) ◽  
Author(s):  
S. L. Douglas ◽  
B. J. Daly ◽  
N. J. Meropol ◽  
A. R. Lipson
Keyword(s):  
Quality Of Life ◽  
Visual Analog Scale ◽  
Metastatic Cancer ◽  
Absolute Difference ◽  
Analog Scale ◽  
Goals Of Care ◽  
Delivery Of Care ◽  
Patient Goals ◽  
Length Of Life

Background Shared decision-making at end of life (eol) requires discussions about goals of care and prioritization of length of life compared with quality of life. The purpose of the present study was to describe patient and oncologist discordance with respect to goals of care and to explore possible predictors of discordance.Methods Patients with metastatic cancer and their oncologists completed an interview at study enrolment and every 3 months thereafter until the death of the patient or the end of the study period (15 months). All interviewees used a 100-point visual analog scale to represent their current goals of care, with quality of life (scored as 0) and survival (scored as 100) serving as anchors. Discordance was defined as an absolute difference between patient and oncologist goals of care of 40 points or more.Results The study enrolled 378 patients and 11 oncologists. At baseline, 24% discordance was observed, and for patients who survived, discordance was 24% at their last interview. For patients who died, discordance was 28% at the last interview before death, with discordance having been 70% at enrolment. Dissatisfaction with eol care was reported by 23% of the caregivers for patients with discordance at baseline and by 8% of the caregivers for patients who had no discordance (p = 0.049; φ = 0.20).Conclusions The data indicate the presence of significant ongoing oncologist–patient discordance with respect to goals of care. Early use of a simple visual analog scale to assess goals of care can inform the oncologist about the patient’s goals and lead to delivery of care that is aligned with patient goals.

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