Background: Despite guidelines advocating that patients with advanced cancer receive dedicated palliative care (PC) services, many patients lack access. Improved training in PC for hematology-oncologists could help, yet studies have shown deficits in PC knowledge and education. We designed a novel longitudinal, PC continuity rotation for hematology-oncology (H/O) fellows and assessed feasibility, acceptability, value, and impact. Methods: Fellows from a single cancer center in the United States prospectively identified patients with PC needs from their H/O continuity practice and referred them to PC to follow in both clinics. Participation was tracked for feasibility. Pre- and post-rotation surveys on PC knowledge and skill confidence were compared using generalized linear models. Fellows were also surveyed on acceptability and participated in exit interviews. Results: From 2018 to 2023, 19 fellows participated, each referring 2-4 continuity patients to PC. Fifty-one patients had a total of 132 PC visits, and fellows participated in 125 (95%). From pre- to post-rotation, there was improvement in fellows' PC knowledge (mean 6.44/10 to 7.92, p < 0.01). Ratings of skill confidence improved in 14 of 26 items (p < 0.05), including titrating opioids, estimating prognosis, and working with an interdisciplinary team. Seventeen fellows completed the post-assessment, and 100% agreed it changed clinical practice. In exit interviews, fellows reflected on how meaningful the rotation was. Conclusion: Our novel, longitudinal, PC continuity rotation for H/O fellows was highly feasible, acceptable, and meaningful. The rotation improved PC skills and changed clinical practice, serving as a national model for integrating PC education into H/O fellowship.

Introduction: Aggressive end-of-life (EOL) care for cancer patients can lead to increased hospitalizations and worse quality of death, while goals of care (GOC) discussions including EOL care conversations are associated with fewer hospitalizations and increased hospice use. During hematology-oncology training, fellows should develop communication skills that include eliciting and documenting patients' GOC to provide quality care during EOL. We aimed to determine the frequency of documentation of GOC discussions in fellow's clinics as well as characteristics of EOL care.Methods: This study was conducted at an academic cancer center where year 1-3 fellows retrospectively reviewed patient medical records from July 2016 to June 2017 to identify patient deaths and collect information on hospitalizations, treatment, and place of death to analyze relationships with GOC discussions.Results: Out of 103 patient deaths, 48 (47%) had documented GOC discussions, 69 (67%) patients were enrolled on hospice, and 20 (19%) had an advance directive. GOC discussions were associated with higher hospice enrollment and advance directive documentation and lower hospitalizations.Conclusions: All fellows had at least one patient who died in their patient panels, but less than half of patients had documented GOC discussions. Fellowship programs should consider incorporating quality improvement measures and communication skills training to ensure fellows have competence in GOC communication and EOL care delivery.

Importance Numerous studies show that early palliative care improves quality of life and other key outcomes in patients with advanced cancer and their caregivers, although most lack access to this evidence-based model of care. Objective To evaluate whether delivering early palliative care via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non–small cell lung cancer (NSCLC). Design, Setting, and Participants Randomized, multisite, comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 US cancer centers among 1250 patients within 12 weeks of diagnosis of advanced NSCLC and 548 caregivers. Intervention Participants were randomized to meet with a specialty-trained palliative care clinician every 4 weeks either via video visit or in person in the outpatient clinic from the time of enrollment and throughout the course of disease. The video visit group had an initial in-person visit to establish rapport, followed by subsequent virtual visits. Main Outcomes and Measures Equivalence of the effect of video visit vs in-person early palliative care on quality of life at week 24 per the Functional Assessment of Cancer Therapy-Lung questionnaire (equivalence margin of ±4 points; score range: 0-136, with higher scores indicating better quality of life). Participants completed study questionnaires at enrollment and at weeks 12, 24, 36, and 48. Results By 24 weeks, participants (mean age, 65.5 years; 54.0% women; 82.7% White) had a mean of 4.7 (video) and 4.9 (in-person) early palliative care encounters. Patient-reported quality-of-life scores were equivalent between groups (video mean, 99.7 vs in-person mean, 97.7; difference, 2.0 [90% CI, 0.1-3.9]; P = .04 for equivalence). Rate of caregiver participation in visits was lower for video vs in-person early palliative care (36.6% vs 49.7%; P &lt; .001). Study groups did not differ in caregiver quality of life, patient coping, or patient and caregiver satisfaction with care, mood symptoms, or prognostic perceptions. Conclusions and Relevance The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC, underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery. Trial Registration ClinicalTrials.gov Identifier: NCT03375489

Palliative care (PC) education is a vital and required part of hematology-oncology fellows' education to build PC skills, attitudes, and knowledge. However, previous research has shown that education in PC is inadequate. This narrative review of the literature on primary PC education during hematology-oncology fellowship programs aims at identifying the current state of PC education, existing gaps, and potential future directions for improving PC education. Fourteen articles were identified and reviewed. The types of articles included trainee and program leadership responses, and interventions designed to improve PC education. Results from each study are reported. Overall, trainees and program leadership rate current PC education as varied, often inadequate, and in need of improvement. Educational interventions show that some form of PC education increases perceived knowledge and confidence in PC skills. Future studies are needed to develop the most effective and impactful educational models.

BackgroundThe engagement of family caregivers in oncology is not universal or systematic. ObjectiveWe implemented a process intervention (ie, patient-caregiver portal system) with an existing patient portal system to (1) allow a patient to specify their caregiver and communication preferences with that caregiver, (2) connect the caregiver to a unique caregiver-specific portal page to indicate their needs, and (3) provide an electronic notification of the dyad’s responses to the care team to inform clinicians and connect the caregiver to resources as needed. MethodsWe assessed usability and satisfaction with this patient-caregiver portal system among patients with cancer receiving palliative care, their caregivers, and clinicians. ResultsOf 31 consented patient-caregiver dyads, 20 patients and 19 caregivers logged in. Further, 60% (n=12) of patients indicated a preference to communicate equally or together with their caregiver. Caregivers reported high emotional (n=9, 47.3%), financial (n=6, 31.6%), and physical (n=6, 31.6%) caregiving-related strain. The care team received all patient-caregiver responses electronically. Most patients (86.6%, 13/15 who completed the user experience interview) and caregivers (94%, 16/17 who completed the user experience interview) were satisfied with the system, while, of the 6 participating clinicians, 66.7% agreed “quite a bit” (n=1, 16.7%) or “very much” (n=3, 50%) that the system allowed them to provide better care. ConclusionsOur findings demonstrate system usability, including a systematic way to identify caregiver needs and share with the care team in a way that is acceptable to patients and caregivers and perceived by clinicians to benefit clinical care. Integration of a patient-caregiver portal system may be an effective approach for systematically engaging caregivers. These findings highlight the need for additional research among caregivers of patients with less advanced cancer or with different illnesses.

Outcomes 1. Describe the challenges faced by HPM clinicians navigating mental illness 2. Identify effective strategies for navigating mental illness as an HPM clinician and for supporting colleagues facing mental health challenges 3. Reflect on the opportunities afforded by the experience of mental illness to influence one's practice as a clinician, educator, and colleague Although burnout, wellness, and resilience are well-described topics in the HPM community, mental illness and its impact are underrecognized and remain stigmatized. This forum brings together palliative care physicians who have faced mental illness and reflected carefully on how the experience has affected their practice. During the session, clinicians will share their personal and professional experiences, highlighting challenges, helpful strategies, and opportunities for a pathway forward. There is growing societal awareness of the mental health crisis among healthcare workers, catalyzed in part by the COVID-19 pandemic. In addition to the stigma and poor access to care faced by most people with mental illness, healthcare workers face concerns about transparency in the workplace, job security, and licensing as they seek evaluation and treatment. Palliative care practice is challenging even in times of emotional stability and presents unique work-related mental health threats and opportunities. Clinicians support patients and families struggling with crises and difficult emotions, often at the intersection of life and death. This close proximity to death heightens the awareness of the shared vicissitudes of life, serving as both an opportunity for transformation and a professional hazard. As mental illness is a biopsychosocial process, treatment often requires a multidimensional approach. Individuals, teams, extended support networks, and the field of palliative care can employ physical, emotional, practical, spiritual, and social approaches to management and healing. Additionally, despite the many challenges, positive reflections and unexpected opportunities may arise as clinicians navigate mental health concerns. Vulnerability can foster strength in our shared experiences and empathy in our work. Ultimately, these experiences may help us grow in our roles as clinicians and educators. This session aims to build community, model how clinicians can navigate care, and expand the dialogue about mental illness among palliative care professionals.

We have developed an integrated caregiver patient-portal system (i.e., patient–caregiver portal) that (1) allows a patient to identify their primary caregiver and their communication preferences with that caregiver in the healthcare setting; (2) connects the caregiver to a unique portal page to indicate their needs; and (3) informs the healthcare team of patient and caregiver responses to aid in integrating the caregiver. The purpose of this manuscript is to report on the formative phases (Phases I and II) of system development. Phase I involved a pre-assessment to anticipate complexity or barriers in the system design and future implementation. We used the non-adaption, abandonment, scale-up, spread, and sustainability (NASSS) framework and rubric to conduct this pre-assessment. Phase II involved exploring reactions (i.e., concerns or benefits) to the system among a small sample of stakeholders (i.e., 5 palliative oncology patients and their caregivers, N = 10). The purpose of these two phases was to identify system changes prior to conducting usability testing among patient/caregiver dyads in palliative oncology (phase III). Completion of the NASSS rubric highlighted potential implementation barriers, such as the non-uniformity of caregiving, disparities in portal use, and a lack of cost–benefit (value) findings in the literature. The dyads’ feedback reinforced several NASSS ratings, including the benefits of connecting caregivers and allowing for caregiver voice as well as the concerns of limited use of patient-portals by the patients (but not the caregivers) and the need for user assistance during stressful health events. One change that resulted from this analysis was ensuring that we provided research participants (users) with detailed guidance and support on how to log in and use a patient–caregiver portal. In future iterations, we will also consider allowing more than one caregiver to be included and incorporating additional strategies to enable caregivers to interact in the system as part of the care team (e.g., via email).

Background:Despite recommendations and policies to integrate family caregivers into U.S. healthcare settings, caregivers are not systematically involved. Thus, we developed an Integrated Caregiver Patient-Portal system that (1) allows a patient to identify their primary caregiver and their communication preferences; (2) connects the caregiver to a unique portal page to indicate their needs; and 3) informs the care team of dyad responses to aid in integrating the caregiver.Objective:This formative research explored palliative care clinicians' perceptions of the system to inform refinements before usability testing.Methods:We conducted two focus groups with palliative care clinicians (N=11) at an NCI-designated cancer center. Transcripts were analyzed using an integrated approach to specify system benefits and concerns.Results:The most referenced benefits included: Learning information that they might not have known without the system; giving caregivers a voice or a way to express needs; and supporting an ideal model of care. Top concerns included lacking capacity to respond; needing to clarify clinician roles and expertise in responding to caregivers' needs; and ensuring ongoing system adaptability.Conclusions:The clinicians' feedback resulted in revisions including: (1) modifying the caregiver questions; (2) integrating social workers in the response; and (3) adding a text-based report to the care team.Implications for Practice:This formative research provided valuable feedback for portal development, and also contributes more broadly to recommendations related to integrating caregivers in healthcare.Foundational:This research provides practical and logistical relevance to the discussion on how to integrate caregivers into clinical care.

Background: Gastrostomy tubes (G-tubes) are invaluable clinical tools that play a role in palliation and nutrition in patients with cancer. This study aimed to better understand the risks and benefits associated with the placement and maintenance of G-tubes. Methods: Patients who underwent placement of a G-tube for cancer from January 2013 through December 2017 at a tertiary care center were considered for inclusion. Clinical data were retrospectively collected from medical records. Results: A total of 242 patients with cancer, whose average age at diagnosis was 61 years (range, 21-94 years), underwent G-tube placement for nutrition (76.4%), decompression (22.7%), or both (0.8%). Successful insertion was achieved in 96.8%, but 8 patients required >1 attempted method of insertion. In the decompression group, minor postplacement complications were less common (23.6% vs 53.5%; P<.001) and survival was shorter (P<.001) compared with the nutrition group. For those with decompressive G-tubes, 45.5% had a palliative care consult; 56.4% were seen by social workers; and 46.3% went to hospice. The frequency of hospice discharge was higher in patients who had consults (53.7% vs 23.1%; P=.01). Conclusions: Half of the patients who received decompressive G-tubes presented with stage IV disease and died within 1 month of placement. Those with >1 consult were more likely to be discharged to hospice. Patients with G-tubes for nutrition saw no change in functionality, complication rate, or survival, regardless of adjunct chemotherapy status. These findings illustrate the need for a tool to allow a better multidisciplinary approach and interventional decision-making for patients with cancer.

Background: Palliative care improves symptoms and coping in patients with advanced cancers, but has not been evaluated for patients with curable solid malignancies. Because of the tremendous symptom burden and high rates of psychological distress in head and neck cancer (HNC), we evaluated feasibility and acceptability of a palliative care intervention in patients with HNC receiving curative-intent chemoradiation therapy (CRT). Methods: This was a prospective single-arm study in HNC patients receiving CRT at a single center in the United States. The intervention entailed weekly palliative care visits integrated with oncology care with a focus on symptoms and coping. The primary outcome was feasibility, defined as a >50% enrollment rate with >70% of patients attending at least half of the visits. To assess acceptability, we collected satisfaction ratings post-intervention. We also explored symptom burden, mood, and quality of life (QOL). Results: We enrolled 91% (20/22) of eligible patients. Patients attended 133 of 138 palliative care visits (96%); all 20 attended >85% of visits. Eighteen of 19 (95%) found the intervention "very helpful" and would "definitely recommend" it. QOL and symptom burden worsened from baseline to week 5, but subsequently improved at one-month post-CRT. Overall, patients valued the one-on-one format of the intervention and receipt of additional care. Conclusions: Our palliative care intervention during highly morbid CRT was feasible and acceptable with high enrollment, excellent intervention compliance, and high patient satisfaction. Future randomized studies will further explore the impact on patient-reported outcomes and health care utilization.

Patients receiving curative chemoradiation treatment (CRT) for head and neck cancer (HNC) undergo some of the most intensive treatments in oncology, resulting in immense physical and psychological symptoms. Integrated palliative care (PC) improves symptoms and coping in patients with advanced cancer, but has not been evaluated in patients with curable solid tumors. Thus, we are conducting the first pilot study of a collaborative palliative and oncology care intervention among patients receiving CRT to assess feasibility and acceptability.

•Explain the role of the ACGME in supporting innovation, and describe recent innovations within HPM training.•Assess opportunities for and barriers to potential training innovations within your own institution.•Understand unique generational characteristics, and learn strategies for bridging generational divides. HPM fellowships will need to evolve and innovate to meet the needs of our growing field, its heterogeneous trainees, and our multigenerational learners. The fellowship directors' preconference will help participants draw inspiration from examples of innovation within the HPM fellowship community, and learn how the ACGME can support such innovations from a senior member of its executive staff. The session will also include a workshop on strategies for effective intergenerational communication. This year's program will begin with a description of innovations supported by the ACGME. This will be followed by brief presentations from fellowship colleagues describing innovations in interprofessional and part-time training, as well as pilot projects to create more flexible fellowships for mid-career and distance learners. Following these presentations, break-out groups will explore each participant's opportunities, barriers, and assessment methods for potential innovation. The participants will then share lessons learned and reflect on what palliative care training may look like in the future. In the multigenerational communication workshop, participants will discuss experiences and challenges that they may be facing and explore potential methods to address these challenges. Participants will leave with relevant practical skills in intergenerational communication. By the end of this half-day, participants will have developed tools to approach the next generation of fellowship training.

•Identify the challenges and risks related to long-term opioid therapy in cancer patients.•Characterize a successful voluntary opioid taper program in an outpatient palliative care clinic. ASCO Clinical Practice Guidelines for the management of chronic pain in cancer survivors recommend reducing or discontinuing opioids when no longer warranted, although if and how this can be achieved in practice is unknown. We examined the feasibility, impact, and best practices of a voluntary outpatient opioid taper program in cancer survivors on long-term opioid therapy (LTOT) for chronic pain. Eligible patients were followed in an NCI-designated Comprehensive Cancer Center. A retrospective chart review using electronic medical records was conducted in patients whose opioid dose was tapered between October 1, 2013, and April 30, 2018. Demographics, clinical data, and detailed pain regimens were collected. Statistical analyses were conducted to characterize the time from taper initiation to the lowest achieved dose, and to explore the relationships between dose reduction and independent variables. Opioid dose reduction was achieved in 162 (82%) out of 196 patients offered a voluntary taper. 119 (74%) of patients who were tapered had equal or greater than a 50% dose reduction. The average pain scores at baseline and at the time of the lowest tapered dose were unchanged. Less than 10% of patients reported withdrawal symptoms. An initial opioid dose of > 500 oral morphine equivalents at baseline was an independent predictor of a smaller percentage of taper. The presence of a co-morbid psychiatric condition and adjuvant co-analgesics did not significantly affect the amount of the taper. A clinically meaningful and well-tolerated opioid taper is feasible in cancer survivors on LTOT.

Background Circulating tumor DNA (ctDNA) is a promising, non-invasive biomarker for preclinical detection and monitoring of various cancers. The utility of ctDNA assessment in renal cell carcinoma (RCC) in not well established. Here, we evaluate the potential of a bespoke, multiplex PCR, whole exome sequencing (WES)-based approach for ctDNA detection. Methods The cohort consisted of 42 patients with stage Ib-IV RCC who underwent complete surgical resection. ctDNA was measured in plasma samples drawn pre-surgery (n = 34; baseline) and at post-operative time points (n = 41) using the bespoke assay targeting patient-specific tumor variants. Results A median of 11.7 ng (1.4-175 ng) of cfDNA was extracted from a median plasma volume of 3.2 mL (1.2-3.8 mL). ctDNA was detected with a mean mutant molecules/mL of 5.3 (0.22-62). Baseline ctDNA was detected in 41% (14/34) of patients. Presence of ctDNA was significantly associated with increased tumor size (mean 9.7 vs 7.1cm, p Conclusions Presence of presurgical ctDNA strongly correlates with advanced stage RCC. Despite low plasma volumes, the bespoke assay detected ctDNA in 41% of baseline samples. Postoperative ctDNA presence is correlated with clinical relapse. However, absence of ctDNA does not preclude recurrence as RCC is known to shed limited amounts of ctDNA. Higher sample volumes and multiregion tumor biopsies could enhance detection rates. This personalized approach has the potential to be used for ctDNA-based detection of relapse in patients with advanced stage RCC. Legal entity responsible for the study Natera, Inc.; Fox Chase Cancer Center. Funding Natera, Inc.; Fox Chase Cancer Center. Disclosure M. Balcioglu: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. H. Wu: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. S. Dashner: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. S. Shchegrova: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. E. Kalashnikova: Full / Part-time employment: Natera, Inc. H. Pawar: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. R.G. Uzzo: Advisory / Consultancy: Janssen; Advisory / Consultancy: Pfizer; Advisory / Consultancy: Novartis; Advisory / Consultancy: Argos. A. Aleshin: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. H. Sethi: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. R. Salari: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. M. Louie: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. B. Zimmermann: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. P. Abbosh: Advisory / Consultancy, Advisory: Janssen; Advisory / Consultancy, Advisory: AstraZeneca. All other authors have declared no conflicts of interest.

73 Background: Patients receiving curative chemoradiation treatment (CRT) for head and neck cancer (HNC) undergo one of the most intensive treatments in oncology, resulting in immense physical and psychological symptoms. Integrated palliative care can improve symptoms and coping in patients with advanced cancer, but has not been evaluated in patients with curable solid tumors. Thus, we are conducting the first pilot study of a collaborative palliative and oncology care intervention among patients receiving CRT to assess feasibility and acceptability. Methods: Eligible participants include newly diagnosed HNC patients starting curative-intent CRT. The intervention entails weekly in-person palliative care (PC) visits integrated with standard oncology care during CRT, followed by 4 weekly phone calls after CRT ends. The PC visits are conducted primarily by a PC RN, with a supervising MD or NP available. Visits focus on coping and managing prominent symptoms during CRT. PC clinicians also receive a weekly patient-reported symptom assessment. Acceptability of the intervention is assessed at 1 month post CRT. The primary outcome is feasibility, defined as a >50% enrollment rate with >70% of participants attending at least half of the PC visits. Planned accrual is 20 patients. Results: We have enrolled 88% (14/16) of eligible patients to date. 11/14 (79%) have p16+ disease. All 14 have completed CRT and are evaluable for feasibility. Participants attended 98% (94/96) of all possible PC visits and completed 99% (95/96) of weekly symptom assessments. PC clinicians spent an average of 35.5 minutes (SD 15.1) per visit with participants. Among the 10 participants who completed the intervention and are evaluable for acceptability, 100% found the intervention “very helpful” and would “definitely recommend” it to others undergoing CRT. Conclusions: An integrated PC intervention to improve symptoms and coping during CRT for HNC is both feasible and acceptable with a high enrollment rate, excellent intervention compliance, and high patient satisfaction. Future studies will evaluate the effects of the integrated intervention on patient-reported outcomes and health care utilization. Clinical trial information: NCT03760471.

Distress is defined in the NCCN Guidelines for Distress Management as a multifactorial, unpleasant experience of a psychologic (ie, cognitive, behavioral, emotional), social, spiritual, and/or physical nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment. Early evaluation and screening for distress leads to early and timely management of psychologic distress, which in turn improves medical management. The panel for the Distress Management Guidelines recently added a new principles section including guidance on implementation of standards of psychosocial care for patients with cancer.

700 Background: Malnutrition and malignant bowel obstruction (MBO) are common consequences of advanced malignancy. Both lead to a poor prognosis, frequent hospitalizations, and have a negative impact on quality of life. The aim of this study is to explore gastrostomy tube (g-tube) placement practices to better define the role of g-tube role in advanced malignancy. Methods: Patients who underwent g-tube placement at our tertiary cancer care center between 2013 and 2017 were included in this study. Patients’ demographics, diagnosis, procedures, postoperative course, and clinical data were collected. Complications and survival were used as endpoints. Results: Two hundred forty-two cancer patients with an average age at diagnosis of 61 years (range 21-94) underwent g-tube placement for nutrition (76.4%), decompression (MBO) (22.7%), or both (0.8%). Active treatment within 3 months of g-tube insertion was seen in 37.8% of the nutrition group versus 29.1% in the MBO group (p = 0.208). Successful insertion was achieved in 96.8% of patients, but nine patients required more than one method of insertion attempt. In the nutrition group, successful method of insertion was 88.1% in interventional radiology, 8.1% in operating room, and 3.8% in endoscopy suite, compared to 81.8%, 14.5%, and 3.6% for the MBO group, respectively (p = 0.426). Post-placement complications were significantly less common in the MBO group compared to the nutrition group (24.1 vs. 54.3%, p < 0.001). Consultation pattern in the MBO group revealed that 45.5% had a palliative care consult, 56.4% were seen by social work, and 47.3% went to hospice. Survival in the MBO group was significantly shorter than in the nutrition group at 30 days (52.7 vs. 90.3%, p < 0.001), 1-year (54.6 vs. 5.9%, p<0.001), and three years (24.1 vs 1.8%, p = 0.001) after g-tube placement. Conclusions: In our experience, most patients who undergo g-tube insertion are not receiving active treatment and a large proportion of patients who receive a decompressive g-tube have a life expectancy of less than a month. These findings will inform the next step of our study: creating a discussion tool to coordinate better care and interventional decision making for patients with advanced malignancy.