An intervention to increase the rate of timely conversations on goals of care (GOC) between providers and patients with gynecologic cancers facing a high risk of death was developed and tested in a pilot study. Findings from the pilot study of the program were reported in the journal Gynecologic Oncology.
GOC discussions completed in a timely manner can help patients and their families with decision-making regarding care and quality of life, the researchers explained, but they often occur too late for patients with gynecologic cancers.
The intervention was designed by providers in gynecologic oncology and palliative care based at Duke University in Durham, North Carolina. Patients treated in the outpatient setting who were at high risk of death within 6 months were prospectively identified for inclusion in the study. The primary objective was to improve the rate of timely GOC conversations for outpatients with high-risk gynecologic cancer. Timely GOC conversations were those occurring within the first 3 visits following determination of high-risk status.
The intervention included 4 main components: educating clinicians on goal-concordant care, consensus building on a template for GOC documentation that included components of the discussion to be addressed, prospectively identifying patients at high risk, and alerting outpatient clinicians. Some components of the discussion template included such topics as the patient’s understanding of the curability of their cancer and prognosis, goals of care, and treatment options.
The rate of timely GOC conversations was compared between a prepilot cohort and a pilot cohort. The prepilot cohort was evaluated based on previously noted discussions of topics found in the GOC template. In a later postpilot period, the researchers also evaluated GOC documentation rates and outcomes based on an analysis of electronic medical records.
A total of 220 high-risk patients with gynecologic cancers were included in this study, with 96 patients in the prepilot cohort and 124 in the pilot cohort. The rate of timely GOC conversation documentation rose from 30.2% with the prepilot cohort to 88.7% with the pilot cohort (P <.001).
The time between the initial GOC discussion and death also appeared to increase with the intervention (mean 283 days for the pilot cohort vs mean 128 days for the prepilot cohort; P <.001). In the postpilot period, 80.9% of patients with gynecologic cancer had documentation of advance care planning GOC discussions in the final 6 months of life, among whom only 1.9% were given chemotherapy in their last 2 weeks of life.
“Timely goals of care discussions are a critical piece in the delivery of high-quality, goal-concordant cancer care at the end of life,” the researchers concluded.
Davidson BA, Puechl AM, Watson CH, et al. Promoting timely goals of care conversations between gynecologic cancer patients at high-risk of death and their providers. Gynecol Oncol. 2022;164(2):288-294. doi:10.1016/j.ygyno.2021.12.009