Patients’ understanding of treatment decisions: Impact on major quality metrics and patient informed decision-making at end of life.

170 Background: Blue Ridge Cancer Care (BRCC) is a community oncology practice in rural Virginia and West Virginia. BRCC is an ASCO-certified practice and participates in multiple value-based care programs to ensure a quality improvement and patient-centered approach. BRCC serves regions with low health literacy (LHL) which impacts a patient’s ability to self-manage their disease, make informed health-related decisions, and navigate the health system. The top indicators of LHL are being over 65 years old, having less than any college education, and being insured by Medicare or Medicaid which is 63% of BRCC’s patient population. Methods: BRCC conducted a retrospective analysis of our 2023 end-of-life (EOL) quality measures and 1,682 unique National Comprehensive Cancer Network (NCCN) Distress Tool & Problem List assessments. We then matched the results with each patient’s demographics and disease course. Additional research revealed that LHL levels have the greatest impact on patients engaging in their care and ability to make informed decisions at end of life. Results: 21% of patients reported concerns with understanding treatment decisions (n=353) and they had vastly different outcomes compared to patients that did not have concerns (n=1329). A chi-square test was performed to examine the relation between these events, all outcomes were found to be statistically significant. Detailed outcomes are shown (Table). Conclusions: In our review, patients reporting concerns with or understanding treatment decisions had more aggressive EOL care and used more resources from health care systems. BRCC plans to deepen our understanding of this population by using an evidence-based tool that assess a patient’s understanding of their disease severity, perceived curability, and treatment options to identify gaps in a patient’s prognostic understanding and enhance communication between the care team and better support patients informed decision-making at EOL. Population Reported Concerns with/understanding Treatment Decisions = 21% No Concerns with Treatment Decisions = 79% > 3 Emergency department visits in 1 year 19% 8% Chemotherapy in the last 14 days of life 38% 19% Enrolled in Hospice 14% 54%