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. 2022 Aug 5:43:101060.
doi: 10.1016/j.gore.2022.101060. eCollection 2022 Oct.

Gynecologic oncology patient perspectives and knowledge on advance care planning: A quality improvement intervention

Sarah P Huepenbecker  1 , Sophia Lewis  2 , Mark C Valentine  1 , Marguerite L Palisoul  3 , Premal H Thaker  3 , Andrea R Hagemann  3 , Carolyn K McCourt  3 , Katherine C Fuh  3 , Matthew A Powell  3 , David G Mutch  3 , Lindsay M Kuroki  3
Affiliations

Gynecologic oncology patient perspectives and knowledge on advance care planning: A quality improvement intervention

Sarah P Huepenbecker et al. Gynecol Oncol Rep. .

Abstract

Objectives: Assess and improve advance care planning (ACP) awareness and uptake among gynecologic oncology patients.

Methods: Using a quality improvement Plan-Do-Check-Act framework, we completed a single institution needs assessment and intervention. The needs assessment was a 26-question survey assessing baseline ACP knowledge and preferences of gynecologic oncology patients. We used this survey to implement an outpatient intervention in which patients were offered ACP resources (pamphlet, discussion with their gynecologic oncologist, and/or social work referral). We conducted a post-intervention survey among patients who had and had not received ACP resource(s) to assess whether our intervention increased ACP knowledge, discussions, or uptake.

Results: Among 106 patients surveyed in the needs assessment, 33 % had ACP documents, 26 % had discussed ACP with a physician, and 82 % thought discussing ACP was important. The majority preferred these conversations in the outpatient setting (52 %) with their gynecologic oncologist (80 %) instead of nurses or trainees. In the intervention, 526 patients were offered ACP resources. Compared to women who did not receive resources (n = 324), patients who received ACP resource(s) (n = 202) were more likely to have ACP discussions with their gynecologic oncologist (38 % vs 68 %, P = 0.001) and had greater proficiency regarding how to create ACP documents (median score 5/10 vs 8/10, P = 0.048), although they were no more likely to have ACP documented in their electronic medical record (27 % vs 9 %, p = 0.08).

Conclusions: ACP uptake among gynecologic oncology patients is low, but ACP discussions with an oncologist during outpatient visits are important to patients and improve their knowledge regarding completing ACP documents.

Keywords: Advanced care planning; Communication; Gynecologic cancer; Implementation; Quality Improvement.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Fuh reports participation on advisory boards for Aravive and Myriad, grants from Merck, and patents/royalties from Stanford University, outside the submitted work. Dr. Kuroki reports grants from National Center for Advancing Translational Sciences of the NIH (KL2TR002346) and Doris Duke Fund to Retain Clinical Scientists, a patent from the GOG Foundation, and a leadership role as a Junior Board Member of the ASSCP, outside the submitted work. Dr. Powell reports advisory board participation for Merck, GSK/Tesaro, AstraZeneca, Eisai, SeaGen, and Clovis Oncology, outside the submitted work. Dr. Mutch reports leadership roles in the Foundation for Women’s Cancer, NCI Gynecologic Cancer Steering committee, and NCCN Committee for Cervix and Corpus, outside the submitted work. Dr. McCourt reports royalties from UpToDate, outside the submitted work. Dr. Palisoul reports consulting fees from Medtronic, outside the submitted work. There were no other reported conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowsheet of advance care planning quality improvement project.
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