Toward improved goals-of-care documentation in advanced cancer: report on the development of a quality improvement initiative.

backgroundDocumentation of advance care planning for patients with terminal cancer is known to be poor. Here, we describe a quality improvement initiative.

methodsPatients receiving palliative chemotherapy for metastatic lung, pancreatic, colorectal, and breast cancer during 2010-2015 at the Cancer Centre of Southeastern Ontario were identified from electronic pharmacy records. Clinical notes were reviewed to identify documentation of care plans in the event of acute deterioration. After establishing baseline practice, we sought to improve documentation of goals of care and referral rates to palliative care. Using quality improvement methodology, we developed a guideline, a standardized documentation system, and a process to facilitate early referral to palliative care.

resultsDuring 2010-2015, 456 patients were included in the baseline cohort: 63% with lung cancer, 16% with colorectal cancer, 13% with pancreatic cancer, and 7% with breast cancer. Care goals in the event of an acute illness were documented by medical oncologists in 6% of cases (26 of 456). Of the 456 patients, 47% (

conclusionsLow rates of documentation of advance care planning and referral to palliative care persist and have stimulated a local quality improvement initiative.