Use of Machine Learning and Lay Care Coaches to Increase Advance Care Planning Conversations for Patients with Metastatic Cancer

Michael F. Gensheimer*, Divya Gupta, Manali I. Patel, Touran Fardeen, Rachel Hildebrand, Winifred Teuteberg, Briththa Seevaratnam, Mary Khay Asuncion, Nina Alves, Brian Rogers, Jennifer Hansen, Jan Denofrio, Nigam H. Shah, Divya Parikh, Joel Neal, Alice C. Fan, Kaidi Moore, Shann Ruiz, Connie Li, Ali Raza KhakiJudy Pagtama, Joanne Chien, Tiffany Brown, Alison Holmes Tisch, Millie Das, Sandhya Srinivas, Mohana Roy, Heather Wakelee, Nathaniel J. Myall, Jane Huang, Sumit Shah, Howard Lee, Kavitha Ramchandran

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


PURPOSE:Patients with metastatic cancer benefit from advance care planning (ACP) conversations. We aimed to improve ACP using a computer model to select high-risk patients, with shorter predicted survival, for conversations with providers and lay care coaches. Outcomes included ACP documentation frequency and end-of-life quality measures.METHODS:In this study of a quality improvement initiative, providers in four medical oncology clinics received Serious Illness Care Program training. Two clinics (thoracic/genitourinary) participated in an intervention, and two (cutaneous/sarcoma) served as controls. ACP conversations were documented in a centralized form in the electronic medical record. In the intervention, providers and care coaches received weekly e-mails highlighting upcoming clinic patients with < 2 year computer-predicted survival and no prior prognosis documentation. Care coaches contacted these patients for an ACP conversation (excluding prognosis). Providers were asked to discuss and document prognosis.RESULTS:In the four clinics, 4,968 clinic visits by 1,251 patients met inclusion criteria (metastatic cancer with no prognosis previously documented). In their first visit, 28% of patients were high-risk (< 2 year predicted survival). Preintervention, 3% of both intervention and control clinic patients had ACP documentation during a visit. By intervention end (February 2021), 35% of intervention clinic patients had ACP documentation compared with 3% of control clinic patients. Providers' prognosis documentation rate also increased in intervention clinics after the intervention (2%-27% in intervention clinics, P <.0001; 0%-1% in control clinics). End-of-life care intensity was similar in intervention versus control clinics, but patients with ≥ 1 provider ACP edit met fewer high-intensity care measures (P =.04).CONCLUSION:Combining a computer prognosis model with care coaches increased ACP documentation.

Original languageEnglish (US)
Pages (from-to)E176-E184
JournalJCO Oncology Practice
Issue number2
StatePublished - Feb 1 2023

ASJC Scopus subject areas

  • Oncology
  • Health Policy
  • Oncology(nursing)


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