Leveraging EHR tools and social work to improve ACP documentation in older adults.

422 Background: Despite its proven benefits, a substantial number of older adults with cancer do not engage in advance care planning (ACP). While beneficial for all patients, ACP takes on heightened importance in the care of older adults, who often have different priorities compared with younger patients and who have higher rates of cancer-related mortality. The discrepancy between ACP's established value and its low uptake rate highlights the need for systematic, scalable approaches to address this gap. A default ACP intervention for older adults would increase completion of ACP documents and help promote goal-concordant cancer care. Given the constraints on clinician time, there is increasing data to support multidisciplinary ACP interventions to provide this care. Methods: We conducted a single-arm quality improvement pilot from October 2024 to April 2025 at Penn Medicine Princeton Health, a community oncology practice. All patients aged 65 or older with a documented geriatric assessment were included. A clinician-facing electronic health record (EHR) dashboard was used to identify patients with upcoming visits and flag those lacking ACP documentation. We implemented a default offer of a social work ACP visit, wherein the embedded geriatric oncology social worker proactively approached eligible patients during already-scheduled oncology visits. The visit included education about ACP, support in completing an advance directive (AD) and/or physician orders for life-sustaining treatment (POLST), and document expressed preferences in a standardized ACP note. Baseline rates were obtained from the same cohort prior to intervention rollout. ACP documentation rates were reassessed after 6 months. Results: A total of 181 patients were included in the pilot. Over 6 months, 77 patients (43%) completed a social work visit and ACP documentation increased substantially. AD completion increased from 21% to 53%; POLST completion increased from 15% to 31%; and patients with an ACP note on file increased from 17% to 23%. Patients who had completed ACP documentation of any kind were older (median age 80) compared to those who had not completed any (median age 77), which was the only statistically significant difference between these groups (p=0.034). There were no significant differences in terms of race, sex, marital status, or underlying cancer diagnosis or stage. Conclusions: Implementation of a social worker ACP intervention significantly increased the proportion of patients with ACP documentation on file, more than doubling the rate of advanced directives. Effective utilization of EHR dashboards and multidisciplinary care teams is a promising and readily scalable strategy for improving the quality of care in this area. Geriatric oncology patients with: 10/2024 (Baseline) 4/2025 (6 months post-implementation) AD 21% 53% POLST 15% 31% ACP Note 17% 23%