Spiritual Care Support of Goal Concordant Care in the Oncologic Emergency Setting

Abstract

Background

A significant portion of oncology patients visit the emergency department (ED) in the last months of their life, often without advanced care plans (ACP). This leads to fragmented care and inconsistent adherence to patients’ end-of-life wishes.

Objective

To enhance the documentation and adherence to advanced care plans for oncology patients visiting the ED, particularly in the context of end-of-life care preferences.

Methods

This was a retrospective observational study. The data was extracted from Epic ED encounters that occurred during 04/01/2023 through 05/31/2023. Eligibility criteria included patients at least 19 years of age and having at least one of the following: a previous DNR, an out of hospital DNR (OOHDNR), a previous discharge to hospice or an ACP note with Full Code documented as “No”. Descriptive statistics using proportions were used to tabulate differences between the two months of data.

A multidisciplinary team, including clinicians, spiritual care providers, nurses, social workers, and data analysts, initiated a quality improvement project. The project focused on the integration of spiritual care providers in advanced care planning discussions, the optimization of electronic medical records (EMR) for real time identification and management of patients’ care and preferences, and the training of healthcare staff in ACP documentation.

Results

During the two-month study period, a total of 5,125 ED encounters occurred with 4,985 potentially eligible patients and 2,747 (55.1%) ED to hospital admissions. The combined number of patients meeting the patient criteria was 276 (5.5%). The intervention led to a 95% increase in the documentation of ACP notes and 46% increase in Do Not Resuscitate (DNR) orders for patients who had previously expressed a preference for a natural death. It highlighted the role of spiritual care providers as a crucial and underutilized resource in managing end-of -life care discussions.

Discussion

This project underscores the importance of interprofessional collaboration in end-of-life care. The utilization of spiritual care providers in ACP discussions and the use of a more integrated EMR system can improve the alignment of emergency care with oncology patients’ end-of-life preferences, leading to better patient outcomes and potentially reduced healthcare costs.