Timing matters: Impact of early advance care planning conversations on hospice utilization in outpatient oncology.

304 Background: Conversations around Advance Care Planning (ACP) and End of Life (EOL) care are an important aspect of oncology patient care. Literature shows that earlier ACP and EOL discussions with providers help patients better understand their diagnosis, prognosis, and make more informed EOL care decisions. However, providers often struggle with the timing and approach of these sensitive conversations. This study sought to determine if physicians’ timing of ACP and EOL conversations impact patient outcomes of hospice utilization. Methods: 51 physicians in 6 outpatient community oncology practices across the United States were interviewed to explore their views of ACP, EOL care, and the timing of these discussions with patients. The interviews were conducted onsite and with a variety of physicians, regardless of their opinions about ACP. All physicians were asked the same initial questions of “What do you think of when you hear ACP?”, “Do you have ACP conversations with patients?”, and “If yes, how often?”. The interviews evolved based on physician response, eventually exploring their preferences for the timing of initiation of ACP and EOL care discussions. Hospice utilization rates in 2024 were compared between physicians who reported initiating ACP discussions, including hospice, earlier with patients, and those who did not. Hospice utilization rates were gathered from the Practice Insights (PI) Qualified Clinical Data Registry analytics platform integrated with iKnowMed EMR. Results: 53% of physicians interviewed defined ACP as hospice, end-of-life, or code status conversations. This group of providers preferred waiting to conduct ACP discussions until later in a patient’s disease trajectory. However, 33% of physicians interviewed viewed ACP as broader discussions, to include patients’ values, goals and preferences for EOL care. These physicians stated they engage in ACP conversations as early as the first or second visit, especially with patients who have Stage IV disease or have a poor prognosis, introducing hospice as a potential option and revisiting these discussions throughout the course of treatment. PI data showed that providers who engage in early and consistent ACP discussions have a 17% higher hospice enrollment rate compared to their peers. Conclusions: Results suggest that providers who initiate early ACP conversations, including the topic of hospice, with patients diagnosed with Stage IV disease or those with a poor prognosis, are associated with increased rates of hospice enrollment. Frequent and early conversations help align providers and patients and allow for the identification of changes in patient preferences over time. Study limitations include operational barriers to collecting hospice enrollment and death data. It may be valuable to follow these providers over time to determine if their results remain consistent year-over-year.