Objective:

To assess the impact of integrating structured early advanced care planning (SEACP) into care for patients with malignant glioma (MG). 

Background:

SEACP is under-utilized in cancer and critical in MG due to prognosis, progressive cognitive impairment and patient autonomy. 

Design/Methods:

 Providers underwent training and used checklists to conduct SEACP visits that included patients and caregivers. We performed an IRB-approved retrospective analysis of 40 SEACP visits over 2 years. We reviewed documentation of SEACP and evaluated impact on adherence to end-of-life quality measures (EOLQM) and advanced care planning (ACP) documentation. Chi-square and t-tests were used to compare outcomes to a published pre-SEACP cohort from our institution. Qualitative data regarding patient and provider experience was analyzed using thematic content analysis.

Results:

All SEACP visits were conducted by advanced practice providers or registered nurses. 54% were tele-visits. Topics discussed included: existential concerns (85%), ACP documents (81%), clinical concerns (77%), and patient values (74%). Patients who completed SEACP (n=40) were more likely to have ACP documented than patients in pre-SEACP cohort (85% vs. 44%; p<0.05), to have completed ACP documents themselves rather than by a proxy (81% vs. 55.0%; p<.01) and higher hospice enrollment > 7 days before death (89% vs. 70.0%; p<.05). Evaluation of qualitative data revealed that 100% of patients found SEACP to be helpful in decision making. 75% of caregivers agreed that “I understand my loved one’s illness better after this visit” and 100% of providers agreed SEACP “improved understanding of patient wishes.” 

Conclusions: