Goal of Treatment as Part of the Chemotherapy Consent Process

Abstract

Problem: Patients consenting for chemotherapy require a clear understanding of the goal of treatment to make an informed treatment decision reflective of their own goals and values. Identified barriers to patient understanding include lack of information on the consent form and the use of ambiguous language by providers. Both the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) recommend goal of treatment as part of the consent process. Purpose: The purpose of this quality improvement project was to develop and implement a new chemotherapy consent form that includes goal of treatment; to improve documentation compliance and to evaluate patients’ understanding of their treatment goal. Methods: A multidisciplinary committee at the project site decided to include three goals of treatment: curative, palliative, and palliative/life-extending as part of the consent form. Goal definitions using plain language were included to ensure consistency across providers in how these terms were defined during consent conversations. Patient surveys were developed to evaluate perceived satisfaction with the information provided during the consent conversation as well as the patient’s own perceived goal of treatment. Results: Between August 31, 2020 and December 11, 2020, 155 patients were consented for chemotherapy with 54% of patients completing the patient survey. Goal of treatment documentation compliance increased from 8% to 99% with adoption of the new consent form. Goal concordance, defined as a patient’s ability to correctly identify their goal of treatment compared to the physician’s documented goal of treatment, increased from 42% to 61%; an increase of 43%. However, a chi-square test of independence revealed no significant association between the rate of agreement and consent form used (X2 (1, N = 84) = 2.72, p = .10). Conclusions: Goals of treatment are a vital part of consent conversations. Including goal of treatment as part of the consent form creates opportunity for meaningful, in-depth goals of care conversations which can help patients make treatment decisions reflective of their own goals and values. Although improvement in goal concordance did not reach statistical significance, a 43% improvement in concordance with the new consent form cannot be overlooked.