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- Title
Advance Directives for Patients With Breast Cancer: Applying the Right Info/Right Care/Right Patient/Right Time Oncology Model.
- Authors
Ossowski, Stephanie; Lyon, Liisa; Linehan, Elizabeth; Gordon, Nancy P.; Egorova, Olga; Mark, Becky; Beringer, Kimberly; Abbe, Thea; Shirazi, Aida; Weldon, Christine; Trosman, Julia; Ravelo, Arliene; Liu, Raymond
- Abstract
BACKGROUND: Advance directives (AD) are an important component of life care planning for patients undergoing treatment for cancer; however, there are few effective interventions to increase AD rates. In this quality improvement project, the authors integrated AD counseling into a novel right info/right care/right patient/right time (4R) sequence of care oncology delivery intervention for breast cancer patients in an integrated health care delivery system. METHODS: The authors studied two groups of patients with newly diagnosed breast cancer who attended a multidisciplinary clinic and underwent definitive surgery at a single facility. The usual care (UC) cohort (N = 139) received care from October 1, 2019 to September 30, 2020. The 4R cohort (N = 141) received care from October 1, 2020 to September 30, 2121 that included discussing AD completion with a health educator prior to surgery. The authors used bivariate analyses to assess whether the AD intervention increased AD completion rates and to identify factors influencing AD completion. RESULTS: The UC and 4R cohorts were similar in age, gender, race/ethnicity, interpreter need, Elixhauser comorbidity index, National Comprehensive Cancer Network distress score = 5, surgery type, stage, histology, grade, and Estrogen receptor/Progesterone receptor/human epidermal growth factor receptor 2 (ER/PR/HER2) status. AD completion rates prior to surgery were significantly higher for the 4R vs UC cohort (73.8%, 95% confidence interval [CI] [66.5%-81.0%] vs 15.1%, 95% CI [9.2%-21.1%], p < .01) and did not significantly differ by age, race, need for interpreter, or distress scores. CONCLUSION: Incorporation of a health educator discussion into a 4R care sequence plan significantly increased rates of time-sensitive AD completion.
- Subjects
ADVANCE directives (Medical care); CANCER patient care; EPIDERMAL growth factor receptors; PATIENTS' rights; BREAST cancer; INTEGRATED health care delivery; CANCER patients
- Publication
Permanente Journal, 2023, Vol 27, Issue 3, p30
- ISSN
1552-5767
- Publication type
Article
- DOI
10.7812/TPP/22.177