Quality Improvement Initiative for Documenting Goals of Care for Patients With Advanced Cancer


Key Points

  • Documentation of goals-of-care discussion increased from 0% to 31%.
  • Palliative care referral rates increased from 36% to 48%.

In a study reported in the Journal of Oncology Practice, Karim et al found that a quality improvement initiative at a single cancer center improved documentation of goals-of-care discussions and referral to palliative care for patients with advanced cancer.

Study Details

In the study, investigators drafted a guideline for goals-of-care documentation and palliative care referral (using Define, Measure, Analyze, Improve, Control quality improvement [QI] methodology), and designed a standardized documentation system. During a passive phase, physicians were taught how to fill out a goals-of-care form and were encouraged to complete a form whenever an outpatient goals-of-care conversation took place. During the active intervention phase, e-mail reminders were sent to physicians, with a QI scorecard being displayed to document overall and individual physician rates of goals-of-care documentation.  

Effect of Intervention

Between May 2016 and November 2017, a total of 303 unique outpatients were identified at Cancer Centre of Southeastern Ontario who were receiving palliative systemic treatment (52%, 21%, 17%, and 10% with lung, breast, colorectal, and pancreatic cancer, respectively). Rates of goals-of-care documentation improved from 0% at baseline in May 2016 to 3% during the passive phase ending in October 2016 and to 31% in the active phase ending in September 2017. Palliative care referral rates were 36% at baseline and 35% during the passive phase, increasing to 48% during the active phase. No particular patient, physician, or disease characteristic were found to be associated with increased likelihood of goals-of-care discussion or referral to palliative care.

The investigators concluded, “Our QI initiative was successful in improving rates of [goals-of-care] documentation in patients with advanced cancer.”

Safiya Karim, MD, of the University of Calgary Cumming School of Medicine, is the corresponding author for the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.




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