• Mihir N Patel, Alexandria Mara, Yvonne Acker, Jamie Gollon, Noppon Setji, Jonathan Walter, Steven Wolf, S Yousuf Zafar, Suresh Balu, Michael Gao, Mark Sendak, David Casarett, Thomas W LeBlanc, and Jessica Ma.
• Duke University School of Medicine, Durham, North Carolina.
• J Pain Symptom Manage. 2024 Dec 1; 68 (6): 539547.e3539-547.e3.

ContextPrognostication challenges contribute to delays in advance care planning (ACP) for patients with cancer near the end of life (EOL).ObjectivesExamine a quality improvement mortality prediction algorithm intervention's impact on ACP documentation and EOL care.MethodsWe implemented a validated mortality risk prediction machine learning model for solid malignancy patients admitted from the emergency department (ED) to a dedicated solid malignancy unit at Duke University Hospital. Clinicians received an email when a patient was identified as high-risk. We compared ACP documentation and EOL care outcomes before and after the notification intervention. We excluded patients with intensive care unit (ICU) admission in the first 24 hours. Comparisons involved chi-square/Fisher's exact tests and Wilcoxon rank sum tests; comparisons stratified by physician specialty employ Cochran-Mantel-Haenszel tests.ResultsPreintervention and postintervention cohorts comprised 88 and 77 patients, respectively. Most were White, non-Hispanic/Latino, and married. ACP conversations were documented for 2.3% of hospitalizations preintervention vs. 80.5% postintervention (P<0.001), and if the attending physician notified was a palliative care specialist (4.1% vs. 84.6%) or oncologist (0% vs. 76.3%) (P<0.001). There were no differences between groups in length of stay (LOS), hospice referral, code status change, ICU admissions or LOS, 30-day readmissions, 30-day ED visits, and inpatient and 30-day deaths.ConclusionIdentifying patients with cancer and high mortality risk via machine learning elicited a substantial increase in documented ACP conversations but did not impact EOL care. Our intervention showed promise in changing clinician behavior. Further integration of this model in clinical practice is ongoing.Published by Elsevier Inc.

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