Impact of Implementing Serious Illness Conversations Across a Comprehensive Cancer Center Using an Interdisciplinary Approach.

Karen Guo, Garrett Wasp, Maxwell Vergo, Matthew Wilson, Megan M Holthoff, Madge E Buus-Frank, James J Perry, Amelia M Cullinan
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Abstract

Background: Gaps in communication of end-of-life care preferences increase risk of patient harm. Adoption of oncology practice guidelines advocating serious illness communication for patients with advanced cancer is limited.

Objectives: (1) Increase Serious Illness Conversation (SIC) use across oncology teams via an interdisciplinary quality improvement (QI) approach and (2) assess patient reported shared decision making (SDM) experiences with clinicians engaged in SIC implementation.

Design: QI methodology was applied to spread the implementation of SIC across 4 oncology teams. CollaboRATE scores were used to evaluate patient reported outcomes of SDM for patients with advanced cancer.

Settings/subjects: The SIC QI initiative was a component of the Promise Partnership Learning Health System (PPLHS) piloted in the Dartmouth Cancer Center, Lebanon, NH, USA.

Measurements: (1) The percentage of eligible patients with documented SIC and (2) a comparison of a patient reported measure of SDM (CollaboRATE) among SIC eligible patients in encounters with providers who took part in the implementation versus those who did not.

Results: Oncology teams screened a total of 538 patients, identified 278 eligible patients, and completed 144 SIC conversations. The teams improved the proportion of documented SIC among eligible patients from near 0% to a collective frequency of 52%. For clinicians' top-box CollaboRATE scores, a chi-squared test demonstrated a statistically significant association between providers implementing SIC into practice and patient reported shared decision making (.16, p = .031).

Conclusions: This approach allows for tailoring of iterative improvement cycles to mitigate barriers and improve the practice of SIC among oncology teams.

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综合癌症中心采用跨学科方法开展重病对话的影响。
背景:临终关怀偏好沟通方面的不足会增加对患者造成伤害的风险。目标:(1) 通过跨学科质量改进(QI)方法,提高肿瘤团队对重病沟通(SIC)的使用率;(2) 评估患者报告的与参与实施重病沟通的临床医生共同决策(SDM)的经验:设计:采用 QI 方法在 4 个肿瘤团队中推广实施 SIC。采用 CollaboRATE 评分来评估晚期癌症患者的 SDM 患者报告结果:SIC QI 计划是美国新罕布什尔州黎巴嫩达特茅斯癌症中心试点的 Promise Partnership Learning Health System (PPLHS) 的一个组成部分:(测量指标:(1)有 SIC 记录的符合条件的患者比例;(2)患者报告的 SDM 测量指标(CollaboRATE)在与参与实施和未参与实施的医疗服务提供者接触的符合 SIC 条件的患者中的比较:肿瘤团队共筛查了 538 名患者,确定了 278 名符合条件的患者,并完成了 144 次 SIC 对话。在符合条件的患者中,这些团队将记录在案的 SIC 比例从接近 0% 提高到了 52%。对于临床医生的顶格 CollaboRATE 分数,卡方检验表明,医疗服务提供者在实践中实施 SIC 与患者报告的共同决策之间存在统计学意义上的显著关联(.16,p = .031):这种方法可以调整迭代改进周期,以减少障碍并改善肿瘤团队的 SIC 实践。
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