TY - JOUR
T1 - Use of Machine Learning and Lay Care Coaches to Increase Advance Care Planning Conversations for Patients with Metastatic Cancer
AU - Gensheimer, Michael F.
AU - Gupta, Divya
AU - Patel, Manali I.
AU - Fardeen, Touran
AU - Hildebrand, Rachel
AU - Teuteberg, Winifred
AU - Seevaratnam, Briththa
AU - Asuncion, Mary Khay
AU - Alves, Nina
AU - Rogers, Brian
AU - Hansen, Jennifer
AU - Denofrio, Jan
AU - Shah, Nigam H.
AU - Parikh, Divya
AU - Neal, Joel
AU - Fan, Alice C.
AU - Moore, Kaidi
AU - Ruiz, Shann
AU - Li, Connie
AU - Khaki, Ali Raza
AU - Pagtama, Judy
AU - Chien, Joanne
AU - Brown, Tiffany
AU - Tisch, Alison Holmes
AU - Das, Millie
AU - Srinivas, Sandhya
AU - Roy, Mohana
AU - Wakelee, Heather
AU - Myall, Nathaniel J.
AU - Huang, Jane
AU - Shah, Sumit
AU - Lee, Howard
AU - Ramchandran, Kavitha
N1 - Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - 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.
AB - 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.
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UR - http://www.scopus.com/inward/citedby.url?scp=85147893309&partnerID=8YFLogxK
U2 - 10.1200/OP.22.00128
DO - 10.1200/OP.22.00128
M3 - Article
C2 - 36395436
AN - SCOPUS:85147893309
SN - 2688-1527
VL - 19
SP - E176-E184
JO - JCO Oncology Practice
JF - JCO Oncology Practice
IS - 2
ER -