Use of Machine Learning and Lay Care Coaches to Increase Advance Care Planning Conversations for Patients With Metastatic Cancer. Issue 2 (17th February 2023)

• Record Type: Journal Article
• Authors: Gensheimer, Michael F.; Gupta, Divya; Patel, Manali I.; Fardeen, Touran; Hildebrand, Rachel; Teuteberg, Winifred; Seevaratnam, Briththa; Asuncion, Mary Khay; Alves, Nina; Rogers, Brian; Hansen, Jennifer; DeNofrio, Jan; Shah, Nigam H.; Parikh, Divya; Neal, Joel; Fan, Alice C.; Moore, Kaidi; Ruiz, Shann; Li, Connie; Khaki, Ali Raza; Pagtama, Judy; Chien, Joanne; Brown, Tiffany; Tisch, Alison Holmes; Das, Millie; Srinivas, Sandhya; Roy, Mohana; Wakelee, Heather; Myall, Nathaniel J.; Huang, Jane; Shah, Sumit; Lee, Howard; Ramchandran, Kavitha;
• Is Part Of: JCO oncology practice. Volume 19:Issue 2(2023)
• Page Start: e176
• Page End: e184
• Publication Date: 2023-02-17
• Subjects: Oncology -- Periodicals; Medical Oncology; Neoplasms; Oncology; Periodicals; 616.994
• DOI: 10.1200/OP.22.00128
• Languages: English
• ISSNs: 2688-1527

Abstract

Abstract : 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.