TY - JOUR
T1 - Building an infrastructure and standard methodology for actively engaging patients in advance care planning
AU - Stepan, Karen
AU - Bashoura, Lara
AU - George, Marina
AU - Griffith, Wendy
AU - Meyer, Margaret
AU - Nortjé, Nico
AU - Price, Kristen
AU - Zhukovsky, Donna S.
AU - Rodriguez, Maria Alma
N1 - Funding Information:
AUTHOR CONTRIBUTIONS Conception and design: Karen Stepan, Lara Bashoura, Marina George, Wendy Griffith, Margaret Meyer, Kristen Price, Donna S. Zhukovsky, Maria Alma Rodriguez Financial support: Maria Alma Rodriguez Administrative support: Karen Stepan, Wendy Griffith, Margaret Meyer, Maria Alma Rodriguez Provision of study material or patients: Karen Stepan, Marina George, Wendy Griffith, Margaret Meyer, Kristen Price, Donna S. Zhukovsky, Maria Alma Rodriguez Collection and assembly of data: Karen Stepan, Wendy Griffith, Margaret Meyer, Nico Nortjé Data analysis and interpretation: Karen Stepan, Wendy Griffith, Margaret Meyer, Nico Nortjé Manuscript writing: All authors Final approval of manuscript: All authors Accountable for all aspects of the work: All authors ACKNOWLEDGMENT This project was completed under the guidance and sponsorship of Maria Alma Rodriguez, MD. We thank The University of Texas MD Anderson Cancer Center for supporting this work and allowing us to improve the care we provide our patients, families, and caregivers. We also thank our electronic health record Applications Analyst, Kiet Giang, for the development and implementation of our structured documentation advance care planning note; Ben Mescher, with Electronic Health Record Analytics and Reporting, for the development and implementation of our advance care planning reporting structure; Trevor Mitchell and Katie Brooks with Internal Communications; and the members of MD Anderson’s Psychosocial Council and to Scientific Publications for their editorial support and expertise.
Funding Information:
This project was completed under the guidance and sponsorship of Maria Alma Rodriguez, MD. We thank The University of Texas MD Anderson Cancer Center for supporting this work and allowing us to improve the care we provide our patients, families, and caregivers. We also thank our electronic health record Applications Analyst, Kiet Giang, for the development and implementation of our structured documentation advance care planning note; Ben Mescher, with Electronic Health Record Analytics and Reporting, for the development and implementation of our advance care planning reporting structure; Trevor Mitchell and Katie Brooks with Internal Communications; and the members of MD Anderson’s Psychosocial Council and to Scientific Publications for their editorial support and expertise.
Publisher Copyright:
, Copyright © 2019 American Society of Clinical Oncology. All rights reserved.
PY - 2019
Y1 - 2019
N2 - PURPOSE With little to no infrastructure or standardized methodology in place to actively engage patients in advance care planning (ACP), The University of Texas MD Anderson Cancer Center set out to identify needed resources, develop an intervention to improve ACP, and evaluate the intervention’s effects. METHODS With the support of executive leadership, a multidisciplinary workgroup enlisted the support of ACP champions, performed a root-cause analysis, developed a detailed ACP process flow by provider role, developed patient and family education resources, and developed faculty and staff training materials. The workgroup also implemented two Plan-Do-Study-Act intervention cycles, which identified difficulty using the ACP note function in our electronic health record (EHR) as a barrier to ACP adoption. By educating patients, families, and providers and improving the EHR’s functionality, the workgroup aimed to increase the percentage of ambulatory patients with a diagnosis of advanced or metastatic cancer who had a documented ACP conversation with a provider by their third office visit. Our goal was to improve this percentage from 20% at baseline to 50% after the intervention. Data were obtained from our institution’s EHRs. RESULTS The percentage of patients who had documented ACP conversations increased from 20% at baseline to 34% at the end of fiscal year 2017 and 54% at the end of fiscal year 2018. CONCLUSION Owing to the dedicated efforts of many individuals across the institution, the postintervention goal was surpassed. Additional efforts to facilitate ACP conversations are ongoing.
AB - PURPOSE With little to no infrastructure or standardized methodology in place to actively engage patients in advance care planning (ACP), The University of Texas MD Anderson Cancer Center set out to identify needed resources, develop an intervention to improve ACP, and evaluate the intervention’s effects. METHODS With the support of executive leadership, a multidisciplinary workgroup enlisted the support of ACP champions, performed a root-cause analysis, developed a detailed ACP process flow by provider role, developed patient and family education resources, and developed faculty and staff training materials. The workgroup also implemented two Plan-Do-Study-Act intervention cycles, which identified difficulty using the ACP note function in our electronic health record (EHR) as a barrier to ACP adoption. By educating patients, families, and providers and improving the EHR’s functionality, the workgroup aimed to increase the percentage of ambulatory patients with a diagnosis of advanced or metastatic cancer who had a documented ACP conversation with a provider by their third office visit. Our goal was to improve this percentage from 20% at baseline to 50% after the intervention. Data were obtained from our institution’s EHRs. RESULTS The percentage of patients who had documented ACP conversations increased from 20% at baseline to 34% at the end of fiscal year 2017 and 54% at the end of fiscal year 2018. CONCLUSION Owing to the dedicated efforts of many individuals across the institution, the postintervention goal was surpassed. Additional efforts to facilitate ACP conversations are ongoing.
UR - http://www.scopus.com/inward/record.url?scp=85076447202&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076447202&partnerID=8YFLogxK
U2 - 10.1200/JOP.18.00406
DO - 10.1200/JOP.18.00406
M3 - Article
C2 - 31596647
AN - SCOPUS:85076447202
SN - 1554-7477
VL - 15
SP - e1085-e1091
JO - Journal of oncology practice
JF - Journal of oncology practice
IS - 12
ER -