An Integrated Approach to Selecting a Prepared Medical Decision-Maker

Background: We implemented a systematic multidisciplinary process to engage new outpatients with cancer in selecting and preparing a medical decision-maker. Measures: Templated advance care planning notes and medical power of attorney documents were used in the electronic health record by the third office visit. Intervention: Patients were coached to meet with social work from a “culture of yes,” viewed a video about the importance of selecting a prepared medical a decision-maker in English or in Spanish, and referenced cards containing simple explanations of advance directives when responding to advance directive questions. Outcomes: A total of 351 patients were evaluated. By visit 3, there was no increase in documented social work advance care planning notes in intervention or scanned medical power of attorney documents in the electronic health record. Conclusions/Lessons Learned: This systematic multidisciplinary approach did not engage new outpatients with cancer in preparing a medical decision-maker. More active physician involvement and varied ways of engagement are needed.