Caroline Crooms1, Karen Connor4, Rachelle Morgenstern5, Parul Agarwal2, Jennie Taylor6, Nathan Goldstein3, Barbara Vickrey5
1Department of Neurology, Brookdale Department of Geriatrics and Palliative Care, 2Institute for Healthcare Delivery Science, Tisch Cancer Institute, Department of Population Health Science and Policy, 3Brookdale Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, 4Department of Neurology, University of California, Los Angeles, 5Department of Neurology, Icahn School of Medicine, 6Departments of Neurology and Neurological Surgery, University of California, San Francisco
Objective:
Analyze relationships between receipt of specialty palliative care (SPC) and advance care planning (ACP) among older adults with high-grade glioma (HGG).
Background:
Low rates of SPC referral and ACP have been documented in HGG. Advanced age is a poor prognostic factor in HGG, making ACP documentation vital in older adults.
Design/Methods:
Adults >65 with WHO grade 3 or 4 gliomas and at least one neuro-oncology note were identified retrospectively from an academic health system cancer registry (8/3/2011-1/23/2020). A chart abstraction tool operationalizing National Quality Forum Preferred Practices for Palliative Care was applied to all clinician notes, abstracting note-writer specialty and ACP indicators: discussions of care goals, code status, and hospice. Advance directive presence/absence in each chart was also recorded. To analyze relationships between receipt of SPC and ACP documentation, patients were stratified as SPC or non-SPC and compared on ACP indicators and advance directive completion (Fisher exact test). In the SPC group, we explored odds of documentation by SPC relative to neuro-oncology (McNemar’s test).
Results:
Across 106 patients, ACP documentation frequency by any clinician (neuro-oncologist or SPC) was: goals of care=61.3%, code status=48.1%, hospice=55.7%. Comparing SPC (n=49, 45.8%) and non-SPC groups, more SPC patients had documented goals discussions [83.7% vs 42.1%; p<.01], code status [85.7% vs 15.8%; p<.01], and hospice discussions [81.6% vs 33.3%; p<.01]. The SPC group also had more healthcare proxies [44% vs 7.5%; p<.01] and/or other advance directive [46% vs .5%; p<.01]. Within the SPC group, SPC was more likely than neuro-oncology to have documented goals (odds ratio (OR) 3; [95% CI 1.6, 30.8] or hospice discussions (OR 7; 95% CI [1.1, 8.3]. Code status documentation by neuro-oncology was insufficient to calculate OR.
Conclusions:
ACP documentation and advance directive completion were more common in patients receiving SPC. However, each indicator was undocumented by either specialty for a meaningful proportion of patients.