Quality Initiative Increased Advanced Care Planning Activities

By Leah Lawrence - Last Updated: August 3, 2022

Researchers successfully implemented a quality improvement initiative aimed at increasing the rate of advanced care planning activities for outpatients with metastatic cancer, according to a recent study.

“Advance care planning (ACP) is recommended by the ASCO consensus guidelines and other consensus statements, and is reimbursed by payers,” according to study researchers. “Although there has been healthy debate about the utility of ACP, it remains a central component of comprehensive patient support and is essential for goal-concordant care.”

Looking at their own institution, the researchers found that ACP for outpatients with metastatic cancer was documented in 12% of records as an ACP note, 17% as an advance directive, and 7% as a physician order for life-sustaining therapy (POLST).

They created this initiative to increase ACP awareness by providing regular feedback to oncologists about their patients’ ACP completion and encouraging palliative medicine referrals.

From 2017 to 2020, the initiative screened more than 5,000 total unique cancer patients per year. Quarterly reports were sent to 60 oncologists at three cancer care sites with data on their percentage of ACP activity for patients with metastatic cancer compared with their peers. Oncologists also received a monthly list of patients without ACP activities.

The rate of ACP activities increased from a baseline of 37% in 2017 to 57% by the end of 2020. Palliative medicine consultations more than tripled from 12% in 2017 to 39% in 2020. Additionally, ACP notes increased from 16% to 29%.

No changes in advance directive, or POLST completion, was noted.

“Refining and standardizing ACP conversations and documentation templates, as well as providing individual feedback on ACP note quality based upon best practices, may also improve the impact of ACP activities on outcomes for patients and their families,” the researchers wrote.

“Educational initiatives designed to improve serious illness communication skills of providers who care for patients with advanced disease would also contribute to positive impact and outcomes from ACP completion.”


Advance Care Planning in Patients With Metastatic Cancer: A Quality Improvement Initiative