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Early Implementation of Advance Care Planning in Oncology Patients

Monday, August 2, 2021

Approximately 1.7 million people in the United States are diagnosed with cancer every year.  Individuals with advanced cancer are faced with challenging treatment decisions. Their choices are highly influenced by their understanding of the disease course and their prognosis. Individuals facing a diagnosis of advanced cancer should have a clear understanding of their medical plan of care. To ensure patient-centred care, palliative care interventions should account for individuals’ unique care goals and preferences, key components of Advance Care Planning (ACP). 

ACP provides a structured approach that allows Individuals, caregiver, loved ones and physicians to discuss goals of care and future decision making. It can be an emotional comfort to the patient and their family to know that their wishes are clearly written out if their condition changes. It allows the family to focus more on caring for their loved one than worrying about making the right decision. It also decreases the guilt that can sometimes happen when the family has to make a decision they are unsure about.

Growing evidence indicates that ACP is necessary in oncology Individuals. Individuals with advanced cancer benefit from honest conversations at the time of their initial cancer diagnosis and shared decision-making based on their individual care goals. The benefits of ACP have been widely published and have been associated with lower rates of ventilation, resuscitation, intensive care unit admission, earlier hospice enrollment and decreased cost of care at the end of life. Aggressive care at the end of life was associated with worse patient quality of life, as well as a higher risk of major depressive disorder in bereaved caregivers.

Advance care planning is rapidly becoming not just a recommendation but an expectation in the outpatient oncology setting, with the Oncology Care Model requiring ACP in the first three visits for all new Individuals. The American Society of Clinical Oncology (ASCO) and the Community Oncology Alliance (COA) recently released updated standards for the Oncology Medical Home (OMH), putting added emphasis on the importance of Palliative Care and ASCO’s Quality Oncology Practice Initiative, which seek promote safety and best practices in the administration of chemotherapy. 

A joint statement from the 2 groups states that the new standards offer a roadmap for delivering “equitable, high-quality cancer care.” In their statement, ASCO and COA say that the standards “provide an opportunity for the entire oncology community to work towards a value-based model of care that will benefit all Individuals with cancer.” The new standards are the basis of an upcoming 2-year, ASCO-led OMH certification pilot. The standards cover 7 areas of cancer care:

  1.  patient engagement, which includes shared decision-making
  2.  access to care in the right place at the right time
  3.  value-based treatment, including documentation of the use evidence and clinical pathways, and referral to clinical trials
  4. access to equitable, comprehensive, and coordinated, team-based care
  5. continuous practice quality improvement, including the use of data and patient-reported outcomes
  6. advance care planning, palliative, and end-of-life care, including discussions of goals
  7. adherence to chemotherapy standards based on QOPI certification program standards

When properly executed, ACP allows Individuals to have clear expectations of their treatment course and physical condition, specify a healthcare proxy that is familiar with their wishes, document their treatment preferences and discuss end-of-life care clearly with their care teams. 

Delayed ACP discussions frequently result in unwanted care that does not improve or extend a patient’s life. National guidelines suggest that Individuals should be encouraged to consider ACP early in their disease course, allowing them to carefully consider their own wishes, share their wishes with those that are close to them and discuss  end-of-life care goals openly and comfortably with their care team.

At Iris, our goal is to provide an environment where each individual is able to make fully informed, thoughtful decisions regarding their current and future healthcare needs and have them respected and supported by their care team and family members. Our highly personalized ACP services are designed to support both caregivers and individuals with serious illness. We start the planning process early, allowing everyone involved to feel confident about their care choices. Our deep experience in goals of care planning allow us to provide guidance to members through the full lifecycle of the ACP process including discussion, creation, distribution and implementation of care plans.

Iris healthcare experts perform in depth, personalized and disease specific Advance Care Planning, providing guidance to individuals and family members through the full lifecycle of the ACP process. This approach creates a supportive, guided process for individuals to create high-quality care plans.

Our expert healthcare facilitators take the time to help individuals:

  • Learn about medical treatment options and the goals for those treatments
  • Explore thoughts and feelings about lifesaving or life-sustaining treatments
  • Choose someone to represent their choices (healthcare proxy) if they are unable to speak for themselves
  • Document those wishes into state specific ADs and Iris Summary
  • Share executed documents to all stakeholders (family, caregivers, points of care)
  • Ensure that loved ones and healthcare providers are aware of healthcare wishes

Our proprietary, disease-specific advance directive documentation captures care goals in straightforward terms, removing complexity for family members during the event of a medical emergency. Our ACP services have resulted in less stress and higher satisfaction levels for individuals and their families due to the identification and documentation of unwanted, unnecessary and/or non-beneficial care.

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