Use of Machine Learning and Lay Care Coaches to Increase Advance Care Planning Conversations for Patients With Metastatic Cancer

被引：11

作者：

Gensheimer, Michael F. ^{[1
]}

Gupta, Divya ^{[1
]}

Patel, Manali I. ^{[1
,2
]}

Fardeen, Touran ^{[1
]}

Hildebrand, Rachel ^{[1
]}

Teuteberg, Winifred ^{[1
]}

Seevaratnam, Briththa ^{[1
]}

Asuncion, Mary Khay ^{[1
]}

Alves, Nina ^{[1
]}

Rogers, Brian ^{[1
]}

Hansen, Jennifer ^{[1
]}

DeNofrio, Jan ^{[1
]}

Shah, Nigam H. ^{[1
]}

Parikh, Divya ^{[1
]}

Neal, Joel ^{[1
]}

Fan, Alice C. ^{[1
]}

Moore, Kaidi ^{[1
]}

Ruiz, Shann ^{[1
]}

Li, Connie ^{[1
]}

Khaki, Ali Raza ^{[1
]}

Pagtama, Judy ^{[1
]}

Chien, Joanne ^{[1
]}

Brown, Tiffany ^{[1
]}

Tisch, Alison Holmes ^{[1
]}

Das, Millie ^{[1
]}

Srinivas, Sandhya ^{[1
]}

Roy, Mohana ^{[1
]}

Wakelee, Heather ^{[1
]}

Myall, Nathaniel J. ^{[1
]}

Huang, Jane ^{[1
]}

Shah, Sumit ^{[1
]}

Lee, Howard ^{[1
]}

Ramchandran, Kavitha ^{[1
]}

机构：

[1] Stanford Univ, Sch Med, Stanford, CA USA

[2] VA Palo Alto Hlth Care Syst, Palo Alto, CA USA

来源：

JCO ONCOLOGY PRACTICE | 2023年 / 19卷 / 02期

关键词：

PALLIATIVE CARE; END; LIFE; AGGRESSIVENESS; IMPLEMENTATION; ADULTS;

D O I：

10.1200/OP.22.00128

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

PURPOSE:Patients with metastatic cancer benefit from advance care planning (ACP) conversations. We aimed to improve ACP using a computer model to select high-risk patients, with shorter predicted survival, for conversations with providers and lay care coaches. Outcomes included ACP documentation frequency and end-of-life quality measures.METHODS:In this study of a quality improvement initiative, providers in four medical oncology clinics received Serious Illness Care Program training. Two clinics (thoracic/genitourinary) participated in an intervention, and two (cutaneous/sarcoma) served as controls. ACP conversations were documented in a centralized form in the electronic medical record. In the intervention, providers and care coaches received weekly e-mails highlighting upcoming clinic patients with < 2 year computer-predicted survival and no prior prognosis documentation. Care coaches contacted these patients for an ACP conversation (excluding prognosis). Providers were asked to discuss and document prognosis.RESULTS:In the four clinics, 4,968 clinic visits by 1,251 patients met inclusion criteria (metastatic cancer with no prognosis previously documented). In their first visit, 28% of patients were high-risk (< 2 year predicted survival). Preintervention, 3% of both intervention and control clinic patients had ACP documentation during a visit. By intervention end (February 2021), 35% of intervention clinic patients had ACP documentation compared with 3% of control clinic patients. Providers' prognosis documentation rate also increased in intervention clinics after the intervention (2%-27% in intervention clinics, P < .0001; 0%-1% in control clinics). End-of-life care intensity was similar in intervention versus control clinics, but patients with >= 1 provider ACP edit met fewer high-intensity care measures (P = .04).CONCLUSION:Combining a computer prognosis model with care coaches increased ACP documentation.

引用

页码：87 / +

页数：10