This article is more than 5 years old. Information may no longer be current.
Hematologic oncologists likely to report having end-of-life discussions ‘too late’
Click Here to Manage Email Alerts
More than half of hematologic oncologists surveyed reported they conduct end-of-life conversations with their patients at too late a stage, according to a research letter published in JAMA Internal Medicine.
“Existing studies suggest a quality gap with respect to end-of-life (EOL) care for patients with blood cancers, and less timely EOL discussions may be partly to blame,” Oreofe O. Odejide, MD, staff physician at Dana-Farber Cancer Institute and instructor of medicine at Harvard Medical School, and colleagues wrote. “Indeed, patients with blood cancers are more likely to receive chemotherapy and be hospitalized when near death, to die in acute care settings and are less likely to use hospice services than those with advanced solid tumors.”
Odejide and colleagues conducted a postal survey of U.S. hematologists providing direct care to adult patients with blood cancer. Of 609 eligible hematologists, 349 (57.3%; median age, 52 years; 75.4% men) completed the survey. Approximately 55% of respondents practiced in community medical centers.
The survey queried whether EOL discussions occurred “too early,” “at the right time” or “too late.” Hematologists also were asked if they conduct discussions about specific aspects of EOL care “upon presentation or diagnosis,” “upon disease progression,” “during an acute hospitalization” or “when death is clearly imminent.”
Among the 345 hematologists who answered the question about timing of EOL discussions, 55.9% responded that these discussions occurred “too late.” A greater proportion of clinicians who worked at tertiary centers reported delayed EOL discussions than those in community practices (64.9% vs. 48.7%; P = .003).
When asked about specific aspects of EOL care, 42.5% of respondents reported conducting their first conversation about resuscitation at suboptimal times, including during acute hospitalization (33.6%) and when death was clearly imminent (8.9%). Clinicians also reported waiting until death was clearly imminent to discuss hospice care (23%) and preferred site of death (39.9%).
There are a few factors that may contribute to the timing of EOL discussions for patients with hematologic malignancies, Odejide and colleagues wrote.
“First, unlike solid malignant neoplasms, which are incurable when they reach an advanced stage, many advanced hematologic cancers remain potentially curable,” they wrote. “Second, physicians may hesitate to conduct EOL discussions because of fear of affecting patients’ emotional coping capacity and hope or because physicians themselves find it difficult to ‘give up’ on patients they might potentially have cured.
“These findings suggest the need for physician-targeted interventions for improving the timeliness of EOL discussion, especially for patients with hematologic cancers treated in tertiary settings,” researchers wrote.
In an accompanying editorial, Thomas W. LeBlanc, MD, MA, a hematologic oncologist and palliative care specialist at Duke University School of Medicine, noted that a better understanding of supportive care is needed for hematologists to provide optimal EOL care to patients with cancer.
“If palliative care is the answer to the problems in the quality of EOL care in hematologic cancers, researchers must study and better understand the unique needs of patients with hematologic cancers and their oncologists,” LeBlanc wrote. “For example, comparatively little is known about the symptom burden and palliative care needs of patients with hematologic cancers, which are a remarkably heterogeneous collection of disease. Similarly, hematologic oncologists and palliative care specialists together must better understand the unique needs of the specialist who treat these patients as we develop models of concurrent palliative care.” – by Cameron Kelsall
Disclosure: The researchers and LeBlanc report no relevant financial disclosures.
Click Here to Manage Email Alerts