Using IPOS to trigger advance care planning in outpatient palliative oncology: A multicenter real-world study.

Abstract

12052 Background: Advance care planning (ACP) is central to high-quality palliative oncology care; however, in Brazil, ACP is not routinely integrated into clinical practice, making timely patient identification challenging. Patient-reported outcomes, such as the Integrated Palliative Outcome Scale (IPOS), may support earlier and more structured ACP discussions. This study evaluated whether IPOS, alone or combined with functional status and follow-up time, can identify patients undergoing ACP in outpatient palliative oncology. Methods: This multicenter, observational study used real-world data from a national Brazilian program across eight states. Adult patients with cancer who completed the IPOS at program entry were included. Functional status was assessed using the Palliative Performance Scale (PPS). ACP was defined as documented initiation during follow-up. Logistic regression models evaluated associations between IPOS domains, PPS, and ACP, adjusting for follow-up time. Discrimination was assessed using receiver operating characteristic (ROC) curves based on predicted probabilities from the final model. Results: A total of 1,301 patients were included (median age 68 years; SD 15.4), of whom 61.4% were female. The most common cancer types were gastrointestinal (30.3%), breast (16.6%), genitourinary (12.3%), and lung (11.9%). ACP was initiated in 32.1% of patients during follow-up. Median baseline IPOS total score was 22 (SD 10.1) and median PPS at entry was 70 (SD 15.7). Median follow-up time was 11.3 weeks (SD 20.2). Baseline IPOS total score did not discriminate ACP initiation (AUC 0.48), while functional status showed modest inverse discrimination (AUC 0.59). Time in palliative care demonstrated higher standalone discrimination (AUC 0.64). A multivariable model combining functional status, selected IPOS symptom and psychosocial domains, and follow-up time significantly improved discrimination for ACP (AUC 0.66; 95% CI 0.63-0.69). Conclusions: IPOS total score alone does not function as a screening tool for ACP initiation. However, when combined with functional status and longitudinal exposure to palliative care, IPOS symptom and psychosocial domains meaningfully improve identification of patients undergoing ACP. These findings support the use of IPOS as a structured clinical trigger to guide timely ACP discussions in outpatient palliative oncology.