E-Mail Trigger Prompts Clinicians to Discuss Advanced Care Planning with Patients

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An e-mail trigger for ACP in the outpatient oncology clinic is effective in prompting conversations.
An e-mail trigger for ACP in the outpatient oncology clinic is effective in prompting conversations.

An e-mail trigger for advanced care planning (ACP) in the outpatient oncology clinic is effective in prompting conversations about ACP for clinician, a study reported at the 2014 Palliative Care in Oncology Symposium in Boston, Massachusetts (Abstract #84).

Researchers at Dana-Farber Cancer Institute, an outpatient oncology clinic, in Boston, Massachusetts, sought to investigate whether an e-mail trigger to oncology clinicians (physicians, nurse practitioners, and physician assistants) could promote an ACP discussion with patients using the evidence-based Serious Illness Conversation Guide.

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The e-mail trigger was sent to clinicians who believed their patient would die within 1 year. The 88 clinicians enrolled in the study identified 1,743 patients to participate in the study. Preliminary results of the cluster-randomized, controlled study showed that 79% of the 104 patients currently enrolled in the intervention arm had ACP conversations after only one trigger and 92% had discussions after two triggers.

During her presentation, Joanna Paladino, MD, of the Dana-Farber Cancer Institute, said that e-mail triggered advanced care planning conversations that occurred a median of 142 days before death. Triggered visits that did not result in an ACP conversation were most often due to immediate patient issues that would make the conversation inappropriate or rushed, as indicated by the clinicians.

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