Serious Illness Conversation Documentation for Older Adults with High-Grade Glioma: A Mixed-Methods Study

Background Poor prognosis among older adults with high-grade glioma (HGG) heightens need for longitudinal serious illness conversations (SIC). We analyzed SIC quality among older HGG patients with and without palliative care consultation (PCC). Methods We retrospectively identified HGG patients aged ≥65 years from a single-site cancer registry and abstracted SIC documentation from their clinical records. Content: Using an established codebook from the Ariadne Labs Serious Illness Conversation Guide (SICG), a standardized framework for comprehensive, high-quality SIC, we identified documentation about (1) prognostication; (2) goals of care; and (3) end-of-life care planning. Comprehensiveness: Using 16 possible subtopics, we calculated a summary score (range 0–16). Timing: We identified the first occurrence of documentation across disease phases: (1) diagnostic; (2) first-line treatment; (3) second-line treatment; and 4) end of life (after cancer-directed treatment). We compared documentation between patients who 1) received PCC vs not and 2) received early PCC (before second-line treatment) vs later or no PCC. Results Among 158 older adults, 102 (64.6%) had documented SIC: 89 (56.3%) on prognostication; 86 (54.4%) on goals of care; and 79 (50.6%) on end-of-life care. Half the cohort never had documented SIC (35.4%) or had it only in the end-of-life phase (15.8%). Median summary score was higher in patients with any PCC vs none (11 [8, 13] vs 0 [0, 4]; P<.01) and early vs late or no PCC (7 [4, 10] vs 0 [0, 2]; P<.01). Discussion We identified gaps in frequency, timeliness, and scope of SIC documentation. PCC may improve SIC documentation quality.