Goals of Care Discussion for Patients With Advanced Lung and Gastrointestinal Cancer in the Emergency Department of a Comprehensive Cancer Center

Primary Objective:

To compare overall percentage of days spent in an acute care setting over the 30-day period from time of the index emergency department (ED), referred to as Acute Cancer Care Center (ACCC), visit for patients who receive the emergency department-based GOC intervention and those who do not.

Secondary Objective:

To obtain data on rates of admission to the ICU, death in the hospital setting, symptom improvement for participants hospitalized, hospice referral, survival, and 30-day care costs for participants who receive the GOC intervention in the ACCC and those who do not.

Inclusion criteria

• Participant is at least 18 years old presenting to the triage area of the MDACC ACCC for treatment
• Participant has advanced lung or GI cancer. Advanced cancer patient defined as: locally recurrent or metastatic for which there is no curative treatment available.
• Participant screens positive for at least 2 of 3 triple threat conditions (dyspnea, altered mental status, or poor performance status)
• Participant has the ability to speak and write in English
• Participant has the ability to provide consent OR is accompanied by a LAR able to provide consent

Exclusion criteria

• Participant is already enrolled in hospice
• Participant is comatose
• Participant has severe intellectual disability
• Participant has a history of dementia documented in the medical records
• Participant has baseline communication barriers such as aphasia or deafness
• Participant is new to MDACC, without established oncology care at our institution at time of ACCC arrival
• Participant is 18 years or older, currently cared for by pediatrics service
• Pregnant women
• Prisoners