Plan-Do-Study-Act (PDSA) cycles
PDSA #1: In March2019, confirmation of a list of new diagnoses (target list) for which a PPC consult was recommended within 30 days of diagnosis (TABLE 1 ). This list created by the project team with input from oncology leaders was presented to all oncology physician faculty. Consensus and buy-in was obtained resulting in the final target list.
Information dissemination sessions at three oncology clinician meetings explained the purpose of the project, background on the evidence for PPC involvement, survey results, and education on how to introduce PPC to patients and families.
A standard documentation tool in the electronic medical record was developed for clinicians to note if PPC consult was considered, discussed with patient/family, and placed. If a PPC consult was not placed, the tool included space for documenting why the consult was not applicable. The tool was designed to help identify barriers to PPC consultation, including family refusal (Supplemental Figure 1 ).
PDSA #2: Monthly division emails began in July 2019 and incorporated general updates on the project as well as reminders about the target list diagnoses and the standard documentation tool.
PDSA# 3: Monthly patient review by members of the project team began in October 2019. Following review, targeted reminder emails were sent to the primary oncology team of identified patients regarding the target list diagnoses, PPC consult expectation, and documentation tool.