In a large cohort of hematologic oncologists surveyed in the United States, standard end-of-life quality measures were highly acceptable, but unrealistic patient expectations are the greatest impediment to quality end-of-life care, a study published in the Journal of Clinical Oncology has shown.1
Previous research has demonstrated that patients with hematologic malignancies receive suboptimal care at the end of life when evaluated with standard oncology quality measures, such as no chemotherapy within the 2 weeks before death. Because these quality measures were developed primarily for patients with solid tumors, it is unclear if these standards are appropriate for patients with blood cancers.
For the study, researchers at Dana-Farber Cancer Institute in Boston, Massachusetts, surveyed 349 hematologic oncologists about the acceptability of 8 standard end-of-life quality measures in 2015.
Results showed that 6 of the standard 8 measures were considered acceptable, with greater than 75% reporting that 4 were acceptable: hospice admission more than 7 days before death, no chemotherapy within 14 days of death, no intubation in the last 30 days of life, and no cardiopulmonary resuscitation in the last 30 days of life.
Researchers also found that 97.3% of respondents reported “unrealistic patient expectations” as a barrier to quality end-of-life care. “Clinician concern about taking away hope” and “unrealistic clinician expectations” were reported as barriers by 71.3% and 59.0%, respectively.
The authors propose that unrealistic patient expectations may be best addressed by conducting advanced care discussions more timely and effectively.
1. Odejide OO, Cronin AM, Condron NB, et al. Barriers to quality end-of-life care for patients with blood cancers. J Clin Oncol. 2016 Jul 11. doi: 10.1200/JCO.2016.67.8177. [Epub ahead of print]