eP143 - Having the Hard Conversations: Advance Care Planning in Colorectal Surgery Patients

Purpose/Background: Surgical treatment of colorectal malignancies can result in adverse events that negatively impact patient quality of life. In these cases, surrogate decisions makers may have to decide the trajectory of patient care. Despite this, advance care planning (ACP) occurs infrequently prior to oncologic surgery. We provided ACP resources to patients presenting for an initial surgical consultation in order to increase ACP completion prior to surgery.Methods/Interventions: We performed a prospective, single-center study. We included English or Spanish speaking adult patients presenting for initial surgical consultation at an NCI-designated cancer center for a neoplasm or malignancy of the small bowel, appendix, colon, rectum or anus from October 2021 to September 2022. During this visit, patients were provided with ACP resources, including information about ACP, access to an online patient resource on ACP, a copy of an easy-to-complete advance directive and a question prompt list. Chart review was performed to extract demographic and clinical information and establish the rate of ACP completion, defined as the presence of an advance directive available in the patient chart, prior to the intervention and prior to surgery. Rates of ACP completion and patient demographics were calculated using descriptive statistics. A binomial probability test was used to determine the significance of the intervention. The effects of patient and surgeon factors on ACP completion following the intervention were calculated using univariate logistic regression analysis.Results/Outcomes: We provided ACP resources to 199 patients of whom 124 underwent surgery. Of surgical patients, 52.4% were male. Most were white (91.4%) and non-Hispanic (88.4%). The median age was 58 years (IQR 47-70). 61.3% of patients were ASA class 3 or 4. Disease and surgical characteristics are shown in Table 1. The rate of ACP availability increased from 9.7% to prior to the intervention to 26.6% at the time of surgery (p=0.004). New ACP completion following the intervention was not associated with any demographic patient factors including age greater than 65, sex, race or marital status. Patient health characteristics of ASA class, known cancer diagnosis at the time of surgery, operative approach or surgical indication (curative/palliative/diagnostic) were also not associated with new ACP completion following intervention. Finally, no association was found between new ACP completion and attending surgeon sex or specialty (colorectal vs. surgical oncology).Conclusion/

Discussion: Rates of ACP completion increased prior to surgery following a surgical consultation during which ACP resources were provided to patients, however this rate remained low. Further research is needed to identify targeted interventions to increase ACP rates among colorectal surgery patients.Table 1.Disease and surgical characteristics of patients in cohort.