Who is participating in goals of care conversations? A review of a pilot quality initiative to improve documented goals of care conversation in an integrated healthcare system.

308 Background: Goals of care (GOC) conversations are essential in identifying and implementing goal-concordant care for advanced cancer patients. However, there is limited understanding of the context of GOC discussions in clinical practice. As part of the ASCO Quality Training Program, Kaiser Permanente San Francisco Cancer Center (KPSFCC) piloted the initiative I-DO GOC electronic medical record template, increasing GOC documentation by oncology providers from 0% to 47%. Here, we aimed to identify patient, situational and provider characteristics associated with documented GOC for advanced cancer patients. Methods: We identified all adult advanced cancer patients treated at KPSFCC with at least one documented GOC conversation using the I-DO GOC template from January 2022 to May 2022. The conversations’ content and context were compared with clinical, patient and provider characteristics. Results: 178 advanced cancer patients had I-DO GOC documented by 8 oncology attendings and 6 fellows. 51.7% patients were female, 46.1% were Non-Hispanic White and median age was 71 years. The leading cancer types were breast (n=34) and lower gastrointestinal (n=29). Comparison of patient and provider characteristics with clinical context are outlined in Table 1. The most common clinical situations prompting GOC conversations were prognosis discussions (n=102) and changes in condition (n=39). Attendings, when compared to fellows, documented GOC conversations more frequently, were more likely to conduct GOC during brief telephone encounters and were more likely to have GOC with patients alone. While attendings initiated GOC conversations in a variety of clinical contexts, fellows conducted GOC conversations mostly during prognosis discussions. Conclusions: Provider training level and clinical situation were associated with differences in GOC documentation. The higher frequency of GOC documentation among oncology attendings compared to fellows suggests differences in comfort level and experience with GOC discussions. This effort supports further investigation of factors influencing GOC conversations which may improve provider initiation and documentation of these key discussions.[Table: see text]