Recognizing Quality Advance Care Planning Documentation: A Quality Improvement Initiative.

Authors

Maria Teresa Cruz Carreras, Mary Senkel, Linda Luu, Jeff Beno, Kathryn Burk, Brian Cameron, Corbin Dill, Rani Benson, Paulette Cabinte, Florence Maffeu-Tamwo, Smitha Raphel, Ryan Sudario, Rekha Thoppil, Polly Sudario, Maria Soliman, Nico Nortje

Published in

Journal of pain and symptom management. Oct 06, 2026. Epub Oct 06, 2026.

Abstract

ACP documentation in oncology emergency care frequently fails to capture patient values, reasoning, and voice, limiting its clinical utility.
A five-domain ACP Documentation Quality Rubric (patient/family voice, goals/values, decision clarity, shared decision-making, plan integration) classified notes as Basic, Adequate, or Exemplary; the primary outcome was the proportion rated Exemplary.
Six components launched February 2026: provider education, exemplar dissemination, reviewer calibration, a point-of-care poster, unit champions, and formal kudos recognition of exemplary documentation.
Exemplary documentation rose from 14.98% (49/327) at baseline to 21.54% (129/599) post-intervention, a 43.7% relative increase exceeding the 15% target (p=0.016); inter-rater reliability improved (weighted kappa 0.41 to 0.53).
Standardized rubrics paired with peer recognition can measurably improve ACP documentation quality in a high-acuity oncology setting; sustainability and downstream patient outcomes warrant further study.

PMID:
42838154
Bibliographic data and abstract were imported from PubMed on 07 Oct 2026.

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