Patients with advanced cancer want and need to partner with their healthcare team to make treatment decisions that reflect their own values and align with what matters most. “Serious illness conversations” include two equally important parts: clinicians share information about prognosis and treatment options, and patients and loved ones share their values and preferences. Despite professional guidelines recommending early conversations about critical illness for all patients with advanced cancer, these conversations unfortunately often happen late or not at all.
As part of the first part of a larger Dartmouth Cancer Center-wide initiative, a large team of clinician-scientists, clinical partners, data scientists and even a patient partner have implemented a quality improvement that may have increased the frequency and documentation of these important conversations. in two specialized medical oncology clinics. Over the 18-month study period, teams increased their baseline documentation rate from 0% to 70%, or 43 of 63 eligible patients.
The results of the project, “Interdisciplinary approach and patient/family partners to improve critical illness conversations in outpatient oncology”, are recently published in JCO Oncology Practicea review of the American Society of Clinical Oncology.
We partnered with our palliative care colleagues, who provided an evidence-based training program to increase our knowledge, skills and comfort in leading conversations about serious illnesses. »
Garrett T. Wasp, MD, lead author, medical oncologist in the Head & Neck Cancer Program at Dartmouth Cancer Center
The group identified four success factors: standardized work, an engaged interdisciplinary team, engaged patients and families, and system-level support. With the help of Dartmouth Health’s technology team, clinicians were able to document critical illness conversations in a standardized one-page format that is easily accessible within the electronic medical record. The work has also inspired the creation of tools for clinicians that enable automated tracking and reporting of critical illness conversations.
The Serious Illness Conversation Model of Care is an intervention of the Promise Partnership Learning Health System: a joint venture between the Dartmouth Cancer Center, the Dartmouth Institute for Health Policy & Clinical Practice and Dartmouth Health. Co-author and palliative care physician Amelia M. Cullinan, MD, joined by a team of trained communication coaches, expanded the intervention to three additional clinical oncology groups, including two more in the summer of 2022.
“These partnerships have led to a better understanding of strategies that individuals and healthcare systems can use to improve communication and decision-making for all serious diseases, not just cancer,” Wasp says. “More effective patient-clinician communication will lead to better adherence to professional guidelines and should produce more patient-centered care.”
Further publications and presentations at national meetings of this and future work are planned, including the use of patient-reported outcomes to help better access impact.
Dartmouth-Hitchcock Medical Center
Wasp, GT, et al. (2022) Interdisciplinary Approach and Patient/Family Partners to Improve Critical Illness Conversations in Ambulatory Oncology. JCO Oncology Practice. doi.org/10.1200/OP.22.00086.