I’m happy to have stumbled across this great tweet and article by @FabianJohnston from a few months back. As a surgeon who sees lots of cancer patients and palliative medicine doctor, it’s something I think about a great deal. (thread 1/8) https://twitter.com/FabianJohnston/status/1250225824172818434

The eye-catching number in this paper- that only 24% of #cancer patients had prior #advancedcareplanning discussions is so staggeringly low (and I’m pretty sure is even lower at other places); there’s so much room for improvement 2/8

Completing ACP requires initiative, comfort with introducing the topic, time, and specific communication skills to navigate these discussions. 3/8

We certainly don’t have time built into our schedules as surgeons to engage in ACP routinely.

Most of us have not been taught the skills required to have these conversations.

Many are likely not comfortable introducing the topic out of fear of diminishing hope for cure 4/8

While I wish that were not the case, we can still make a huge impact by having initiative and comfort with routinely introducing ACP in a non-threatening way, along with knowledge of the resources at hand at our institutions. 5/8

PCPs with a close relationship with a patient would be the obvious first choice, but many new cancer patients present without established primary care. 6/8

Many hospital systems have services led by non-physicians (sometimes part of a palliative medicine team, but often not) who specialize in conducting ACP. Examples @UWCarbone and @gundersenhealth 7/8

Anyway, I’m glad to see you beating this drum, @FabianJohnston , because there is so much low hanging fruit in improving this aspect of our patients’ care, even if we don’t do it ourselves. end/8