Time of Clinic Appointment and Serious Illness Communication in Oncology

INTRODUCTION: Serious illness communication in oncology increases goal concordant care. Factors associated with the frequency of serious illness conversations are not well understood. Given prior evidence of the association between suboptimal decision-making and clinic time, we aimed to investigate the relationship between appointment time and the likelihood of serious illness conversations in oncology. METHODS: We conducted a retrospective study of electronic health record data from 55 367 patient encounters between June 2019 to April 2020, using generalized estimating equations to model the likelihood of a serious illness conversation across clinic time. RESULTS: Documentation rate decreased from 2.1 to 1.5% in the morning clinic session (8am-12pm) and from 1.2% to .9% in the afternoon clinic session (1pm-4pm). Adjusted odds ratios for Serious illness conversations documentation rates were significantly lower for all hours of each session after the earliest hour (adjusted odds ratios .91 [95% CI, .84-.97], P = .006 for overall linear trend). CONCLUSIONS: Serious illness conversations between oncologists and patients decrease considerably through the clinic day, and proactive strategies to avoid missed conversations should be investigated.