Impact of High-Quality Goals-of-Care Discussions on Oncologist Productivity

Abstract

PURPOSE: To study factors that have an impact on the conduct of high-quality goals of care (GoC) discussions and productivity of oncologists among four different practice settings in patients with advanced cancer. METHODS: Solid-tumor oncologists from community, academic, municipal, and rural hospitals were randomly assigned to receive a coaching model of communication skills to help them facilitate a GoC discussion with newly diagnosed patients with advanced cancer who had a less-than-2-year prognosis. Patients were surveyed after the first restaging visit regarding the quality of the GoC discussion on a scale of 0 to 10 (0, worst; 10, best) with a score of 8 or better indicating a high-quality GoC discussion. Productivity was measured by work revenue value units (wRVUs) per hour for the day each oncologist saw the study patient after imaging. RESULTS: The four sites differed significantly in the socioeconomic patient populations they served and in the characteristics of the oncologists who cared for the patients. Overall median productivity across the four sites was 3.6 wRVU/hour, with the highest observed in the community hospital (4.3 wRVU/hour) and the lowest in the rural setting (2.9 wRVU/hour; P < .001). There was no significant difference in productivity observed when high-quality GOC discussion occurred versus when it did not (3.6 v 3.7 wRVU/hour; P = .86). CONCLUSION: Despite differences in patient populations and oncologists’ characteristics between the four practice settings, the conduct of high-quality GoC discussions did not affect productivity.

Goals of care documentation by medical oncologists and oncology patient end‐of‐life care outcomes

“…However, it meets proposed best practices 26 and clinicians' desire for systematic integration into clinical care, 45 and data suggest that high-quality GOC discussions need not be lengthy 46 and do not affect oncologist productivity. 47 The templated note we implemented was designed by an interdisciplinary group of clinicians with the aim of being brief, user-friendly, and accommodating of clinical team workflows. Additional implementation efforts could be expected to improve performance, which we will continue to study.…”

“…Fifth, we did not survey clinicians' attitudes about our GOC documentation initiative, including perceived benefits or burdens. However, it meets proposed best practices 26 and clinicians' desire for systematic integration into clinical care, 45 and data suggest that high‐quality GOC discussions need not be lengthy 46 and do not affect oncologist productivity 47 . The templated note we implemented was designed by an interdisciplinary group of clinicians with the aim of being brief, user‐friendly, and accommodating of clinical team workflows.…”

Changing Rates of Goals of Care Designations in Patients With Advanced Pancreatic Cancer During a Multifactorial Advanced Care Planning Initiative: A Real-World Evidence Study

“…38 Data also exist that stand in contrast to some of these perceived barriers, including a study that identified no difference in hope among patients with advanced cancer who had completed ACP, 39 and another that identified no difference in productivity among oncologists who performed high-quality GoC discussions. 40 ASCO's recent Patient-Clinician Communication guidelines emphasize early GoC discussions as a key target of effective communication in the setting of palliative cancer, citing evidence that these discussions can support the well-being of patients, families, and clinicians. 1 However, the belief that increasing the frequency of GoC designation is a suitable target for quality improvement is not universal.…”

“…38 Data also exist that stand in contrast to some of these perceived barriers, including a study that identified no difference in hope among patients with advanced cancer who had completed ACP, 39 and another that identified no difference in productivity among oncologists who performed high-quality GoC discussions. 40…”