Survey Shows Clinician Opinions on Timing of End-of-life Discussions for Patients With Blood Cancers

In a survey on end-of-life (EOL) discussions, hematologic oncologists reported that these discussions with patients who have blood cancers occur too late, according to a report published online by JAMA Internal Medicine (doi:10.1001/jamainternmed.2015.6599).

Oreofe O. Odejide, MD, of the Dana-Farber Cancer Institute in Boston, Massachusetts, and coauthors conducted a survey to examine the timing of EOL discussions. Their survey was completed by 349 hematologic oncologists (57.3% response rate).

Approximately 56% of hematologic oncologists (based on a slightly smaller number of respondents who answered a survey question about timing) reported when EOL discussions happen as “too late.” Oncologists in tertiary centers were more likely to report EOL discussions with patients as late compared with those in community centers.

In regard to specific aspects of EOL care, the results show 42.5% of respondents reported conducting their first conversation about resuscitation status at less than optimal times; 23.2% reported waiting until death was clearly imminent before having an initial conversation about hospice care; and 39.9% reported waiting until death was clearly imminent before having an initial conversation about the preferred site of death.

“Several factors may contribute to untimely EOL discussions in hematologic oncology. First, unlike most solid malignant neoplasms, which are incurable when they reach an advanced stage (stage IV), many advanced hematologic cancers remain potentially curable. This lack of a clear distinction between the curative and EOL phase of disease for many hematologic cancers may delay the initiation of appropriate EOL discussions,” the study concluded.

This research was supported by a postdoctoral fellow award from the Lymphoma Research Foundation and a Young Investigator Award from the Conquer Cancer Foundation.

In accompanying commentary (doi:10.1001/jamainternmed.2015.6994), Thomas W. LeBlanc, MD, MA, of the Duke University School of Medicine, Durham, North Carolina, commented, “These findings are important. They provide a better sense of hematologic oncologists' awareness of gaps in the quality of EOL care, confirming that hematologic oncologists generally do not have their ‘heads in the sand' about how they tend to practice.

“Even more importantly, these findings suggest that hematologic oncologists are uncertain about how to actually change the status quo of EOL issues, thereby highlighting a practice gap in need of an intervention. As a practicing hematologic oncologist and a palliative care physician, I believe that the field of hematology should look to specialty palliative care for the answer to this need.”

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