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Zachariah, Finly; Popplewell, Leslie; Forman, Stephen J.; Gorospe, Gerardo; Wong-Toh, Judy; Morse, Denise; Emanuel, Lindsay; Ito-Hamerling, Gayle; Garcia, Nellie; Horak, David; Kassouny, Dicran; Ohanesian, Priscilla; Buga, Sorin; Dale, William; Mooney, Stefanie; Tegtmeier, Bernard; Banerjee, Chandana; Patel, Purvi; Alvarnas, Joseph C.

The advance directive completion rates in the hematopoietic stem cell transplant population in a major transplant cancer center

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  • Media type: E-Article
  • Title: The advance directive completion rates in the hematopoietic stem cell transplant population in a major transplant cancer center
  • Contributor: Zachariah, Finly; Popplewell, Leslie; Forman, Stephen J.; Gorospe, Gerardo; Wong-Toh, Judy; Morse, Denise; Emanuel, Lindsay; Ito-Hamerling, Gayle; Garcia, Nellie; Horak, David; Kassouny, Dicran; Ohanesian, Priscilla; Buga, Sorin; Dale, William; Mooney, Stefanie; Tegtmeier, Bernard; Banerjee, Chandana; Patel, Purvi; Alvarnas, Joseph C.
  • imprint: American Society of Clinical Oncology (ASCO), 2017
  • Published in: Journal of Clinical Oncology
  • Language: English
  • DOI: 10.1200/jco.2017.35.31_suppl.16
  • ISSN: 0732-183X; 1527-7755
  • Keywords: Cancer Research ; Oncology
  • Origination:
  • Footnote:
  • Description: <jats:p> 16 </jats:p><jats:p> Background: Advance Care Planning (ACP) is central to patient-centered care and helps assure treatment aligns with a patient’s goals, values, and priorities. ACP is often poorly incorporated into the hematopoietic stem cell transplantation (HSCT) population, with reported advance directive (AD) rates of 23-50%. At City of Hope National Medical Center (COH), concerted efforts to improve the overall number of ADs in HSCT was undertaken and evaluated. Methods: The Department of Supportive Care Medicine at COH, in collaboration with medical faculty and administrative support, created a patient-centered ACP program. The first two years (2013/2014) broadly focused on all new COH patients. The last two years (2015/2016) included a specific focus on patients undergoing HSCT. The primary goal was a completed AD in the electronic medical record before day 0 of transplant. In addition to provider and transplant team engagement, major time points for supportive care integration to facilitate AD completion were identified including: 1) registration, 2) new patient orientation, 3) the clinical visit when transplant was decided, 4) pre-transplant education class, 5) clinical social work psychosocial assessment visit, and 6) the pre-transplant hospital days. AD completion rates were calculated with Odds Ratio and Mantel-Haenszel Chi-Square using Epi Info StatCalc. Results: Between 2012 and 2016 at COH, 1784 transplants were performed. For HSCT patients in 2012, baseline AD capture rate before day 0 of transplant was 28.6%. With the institutional AD program, the AD capture rate before day 0 of transplant was 31.6% for 2014, compared with 2012 [odds ratio, 1.17(95% CI, 0.85-1.60); p = .33]. With both institutional and hematology specific programs, AD capture rate before day 0 was 69.5% for 2016, compared to 2014[odds ratio, 4.30 (95% CI, 3.14-5.91); p &lt; .001]. Conclusions: Compared to 2012, the institutional AD program in 2014 insignificantly impacted HSCT AD completion rates. Improving the rate of AD completion from 28.6% to 69.5% in HSCT patients required both institutional AD efforts and a targeted program. Nevertheless, more work is needed to improve AD completion rates before transplant to 100%. </jats:p>
  • Access State: Open Access