Caroline Crooms1, Sara Zalcgendler3, Karen Connor4, Jennie Taylor5, Laura Gelfman2, Barbara Vickrey6
1Icahn School of Medicine at Mount Sinai, 2Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 3Medicine, New York University Grossman School of Medicine, 4Independent Consultant, 5University of California, San Francisco, 6Icahn School of Medicine
Objective:
(1) Examine content, comprehensiveness, and timing of documented serious illness conversations (SIC) among older adults with high-grade glioma (HGG); and (2) compare comprehensiveness of documentation among patients who did or did not receive palliative care consultation.
Background:
Longitudinal SIC in oncology helps ensure care plans align with cancer patients’ goals. High-quality SIC is particularly important for older adults with HGG, given poor prognosis and prevalent cognitive deficits affecting decision-making capacity.
Design/Methods:
We retrospectively identified HGG patients aged ≥65 years at diagnosis from an academic health system cancer registry (8/3/2011-1/23/2020) and applied a chart abstraction tool to abstract SIC documentation from their clinical records. Content: We coded text to identify documentation about (1) prognostication; (2) goals of care; and (3) end-of-life care planning. Comprehensiveness: Using 16 possible subtopics, we calculated a summary score (range 0-16). Timing: We identified the first occurrence of documentation across disease phases: (1) diagnostic (pre-chemoradiation); (2) first-line treatment; (3) second-line treatment; and 4) end of life (after cancer-directed treatment). Using linear regression, we evaluated associations between receipt of palliative care and SIC summary score.
Results:
Among 158 older adults, 106 (67%) had any documented SIC: 89 (56%) on prognostication; 86 (54%) on goals of care; and 79 (50%) on end-of-life care. Median SIC score was 7 [interquartile range 3, 12]. First SIC documentation mostly occurred in the diagnostic [n=63 (40%)] or end-of-life phases [n=25 (16%)], but rarely (<10%) in either cancer-directed treatment phase. In linear regression models adjusted for Charlson Comorbidity Index, palliative care consultation was significantly associated with higher SIC score (β=7.0, p<.01).
Conclusions:
SIC documentation was limited in scope, with each of the core topics being undocumented for a substantial percentage of this HGG cohort. For half of the cohort, SIC was first documented in the end-of-life phase or was never documented. Palliative care referral may improve SIC quality.
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