Improving Care for Patients With Cancer Through Early Goal of Care Discussions

Implementing an initiative to standardize electronic documentation of physician-led goals of care (GOC) discussions in patients with cancer led to a significant increase in early documentation and improved care integration across different health care settings according to research published in the Journal of Clinical Oncology.  

Early documentation of physician-led GOC discussions may help ensure comprehensive and individualized quality care for cancer patients, as this information can give the patient care team context for the type of care each patient desires at the end of life. electronic medical records (EMRs) should also provide easy access to these conversations to facilitate seamless integration of outpatient, emergency room, and inpatient care for patients with cancer. 

The initiative to improve GOC discussions was rolled out to Moores Cancer Center faculty at UC San Diego Health between August 2021 and November 2021 through presentations and emails. A SmartPhrase in the EMR Epic was created to include key components of GOC discussions and was radiolabeled for easy access by clinicians. Physician documentation of GOC discussions was tracked to achieve a goal of greater than 50% documentation within 30 days of the first cycle of chemotherapy. At the start, only 4% of patients had a GOC note, but with individual email reminders to physicians, progress was made by December 2021. 

By January 2022, 50% of physicians ordering chemotherapy and 29% of patients initiating chemotherapy were using the GOC SmartPhrase after completing education. After monthly reminder emails were implemented, documentation increased to 51% by October 2022, along with an increase in the use of Advanced Care Planning billing codes. 

“Implementation of an initiative to standardize electronic documentation of GOC conversations improved early documentation of these vital conversations. Radiolabeling of the SmartPhrase made it easily accessible to all members of a patient’s care team,” said researchers.  

Reference 

Vasiljevic K, Kane S, Tuyn B, et al. Implementation of standardized electronic documentation of goals of care discussions to improve cancer care. Journal of Clinical Oncology. 2024;42(16):11127-11127. doi:10.1200/JCO.2024.42.16_suppl.11127