Timing is everything: Improving the frequency, timeliness, and effectiveness of goals of care conversations for oncology patients in Manitoba.
Bibliographic record
Abstract
4 Background: Advanced care planning (ACP) in oncology requires effective communication and coordination. Early and regular ACP discussions are endorsed by ESMO and can help facilitate quality, patient-centered care. Methods: An ACP curriculum was created at CancerCare Manitoba that included health care provider (HCP) engagement, HCP and patient education, improved ACP clinical workflow, and improved ease of ACP documentation in the medical record. We evaluated the occurrence and frequency of ACP discussions before implementation of the ACP curriculum using a random sample of 100 adult patients diagnosed with stage IV solid tumors in Manitoba, Canada during 2014. We compared this group to a similar group of patients from 2017 after ACP curriculum implementation. Differences between the two cohorts were tested using Chi-square and Fisher’s Exact tests. The time from a patient’s first clinic visit with an oncologist to their first ACP conversation was described using cumulative incidence curves with K-sample tests used to test for significant differences between the 2014 and 2017 cohorts. Results: Of the 200 patients selected, 153 were assessed at our provincial cancer center (76 in 2014 and 77 in 2017). The median age for this group was 68. 59% were male. 56% received at least 1 line of chemotherapy. ACP documentation increased from 29% in 2014 to 42% in 2017 (p = 0.10). Between 2014 and 2017, initial ACP discussions occurred at: Initial visit (18% vs. 41%), disease progression (27% vs. 31%) and referral to palliative care (55% vs. 28%). After curriculum implementation ACP documentation occurred earlier in the patient’s cancer journey (p = 0.04). Conclusions: After implementation of an ACP curriculum at our cancer center, ACP discussions occurred more often and earlier, but the difference was only significant for earlier ACP discussions. Even after ACP curriculum implementation, a significant proportion of patients did not have ACP documented in their patient record. Understanding and overcoming barriers related to ACP at our institution will be critical for further ACP documentation improvement.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.027 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".