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. 2023 Jun 2;28(6):542-550.
doi: 10.1093/oncolo/oyad015.

Patient Engagement With Early Stage Advance Care Planning at a Comprehensive Cancer Center

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Patient Engagement With Early Stage Advance Care Planning at a Comprehensive Cancer Center

Donna S Zhukovsky et al. Oncologist. .

Abstract

Background: Establishing care preferences and selecting a prepared medical decision-maker (MDM) are basic components of advance care planning (ACP) and integral to treatment planning. Systematic ACP in the cancer setting is uncommon. We evaluated a systematic social work (SW)-driven process for patient selection of a prepared MDM.

Methods: We used a pre/post design, centered on SW counseling incorporated into standard-of-care practice. New patients with gynecologic malignancies were eligible if they had an available family caregiver or an established Medical Power of Attorney (MPOA). Questionnaires were completed at baseline and 3 months to ascertain MPOA document (MPOAD) completion status (primary objective) and evaluate factors associated with MPOAD completion (secondary objectives).

Results: Three hundred and sixty patient/caregiver dyads consented to participate. One hundred and sixteen (32%) had MPOADs at baseline. Twenty (8%) of the remaining 244 dyads completed MPOADs by 3 months. Two hundred and thirty-six patients completed the values and goals survey at both baseline and follow-up: at follow-up, care preferences were stable in 127 patients (54%), changed toward more aggressive care in 60 (25%), and toward the focus on the quality of life in 49 (21%). Correlation between the patient's values and goals and their caregiver's/MPOA's perception was very weak at baseline, improving to moderate at follow-up. Patients with MPOADs by study completion had statistically significant higher ACP Engagement scores than those without.

Conclusion: A systematic SW-driven intervention did not engage new patients with gynecologic cancers to select and prepare MDMs. Change in care preferences was common, with caregivers' knowledge of patients' treatment preferences moderate at best.

Keywords: advance care planning; advance directives; goal-concordant care; medical power of attorney; surrogate medical decision-maker.

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Conflict of interest statement

Pamela Soliman disclosed grants to the institution from Novartis and Incyte. Dr Soliman also received payments from Amgen and Eisai Medical Research Inc., as well as Medscape as a speaker/preceptorship. The other authors indicated no financial relationships.

Figures

Figure 1.
Figure 1.
Study flow chart, advance care planning (ACP), family caregiver (fCG) gynecologic oncology diagnosis (GYN), medical power of attorney document (MPOAD), and social worker (SW).

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References

    1. Institute of Medicine (IOM). Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. US: The National Academies Press; 2015. - PubMed
    1. Institute of Medicine (IOM). Clinician-patient communication and advance care planning. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Chap. 3. US: The National Academies Press; 2015:117-220. - PubMed
    1. Institute of Medicine (IOM). Introduction. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. The National Academies Press; 2015:21-44. - PubMed
    1. Institute of Medicine (IOM). Summary. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. The National Academies Press; 2015:1-20. - PubMed
    1. Peppercorn JM, Smith TJ, Helft PR, et al. . American Society of Clinical Oncology statement: toward individualized care for patients with advanced cancer. Clin Oncol. 2011;29(6):755-760. 10.1200/jco.2010.33.1744 - DOI - PubMed

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