ABSTRACT
VICTORIA MARIE POILLUCCI. Breaking Down Barriers to Early Goals-of-Care Discussions with Terminally Ill Cancer Patients (Under the direction of DR. KELLY POWERS)
Opportunities to discuss options for care when faced with a life limiting disease is the right of all patients. Yet, healthcare provider feelings of awkwardness, fear of diminishing hope, and fear of failing to cure can result in missed opportunities to explore what patients really want for end-of-life care. Because these Goals-of-Care Discussions are not occurring, patients often receive unwanted and expensive care. The purpose of this quality improvement project was to evaluate the effect of education on oncology providers’ self-efficacy for Goals-of-Care Discussions, and to explore barriers and opportunities to promote completion of earlier Goals-of-Care Discussions. Two white board scribe videos were created to educate providers and for consideration for future use to show patients as an ice breaker to begin these difficult conversations. The sample included 66 Oncologists, Nurse Practitioners, and Physician Assistants from a large academic cancer center in the southeast United States. A Wilcoxon Signed Rank test showed a statistically significant immediate improvement in the oncology provider’s self-efficacy after viewing the videos (p<.001). Thematic analysis revealed 5 themes: lack of sufficient clinic time, provider comfort level, documentation as key to communication, protocol development, and oncologist versus palliative care (whose job is it?). Education for healthcare providers and tools to help initiate conversations with patients can help improve self-efficacy in conducting Goals-of-Care Discussion. Future research is needed to look at the cost of unwanted care and how developing a comfort level with having discussions surrounding end-of-life can reduce healthcare costs and improve patient centered care.