Effect of the Serious Illness Care Program on Health Care Utilization at the End of Life for Patients with Cancer

Abstract

<b><i>Objectives:</i></b> To determine the effect of the Serious Illness Care Program on health care utilization at the end of life in oncology. <b><i>Design:</i></b> Analysis of the secondary outcome of health care utilization as part of a cluster-randomized clinical trial that ran from 2012 to 2016. Clinicians in the intervention group received training, coaching, and system supports to have discussions with patients using a Serious Illness Conversation Guide (SICG); clinicians in the control arm followed usual care. <b><i>Setting/Subject:</i></b> Patients with advanced cancer who died within two years of enrollment at the Dana-Farber Cancer Institute. <b><i>Measurement:</i></b> Health care utilization was abstracted from the electronic medical record using the National Quality Forum (NQF)-endorsed indicators of aggressive cancer care at the end of life and scored from 0 to 6 (one point for each aggressive indicator); <i>t</i> tests and chi-square tests were used to determine differences between intervention and control patients. <b><i>Results:</i></b> The charts of 159 patients who died were reviewed. Neither the main outcome of mean number of aggressive indicators (0.9 vs. 0.9, <i>p</i> = 0.84) nor the proportion of patients with any aggressive care (49% intervention [95% CI: 40-57] vs. 54% control [95% CI: 42-67]) differed between patients in the intervention and control groups. <b><i>Conclusion:</i></b> In this analysis of a secondary outcome from a randomized clinical trial of the Serious Illness Care Program, intervention and control patients had similar end-of-life health care utilization as measured by the mean number of NQF-endorsed indicators. Future research efforts should focus on studying the strategies by which communication about patients' prognosis, values, and goals leads to personalized care plans.