Goals of care discussions for patients with blood cancers: Association of person, place, and time with end‐of‐life care utilization
Open Access
- 8 October 2019
- Vol. 126 (3), 515-522
- https://doi.org/10.1002/cncr.32549
Abstract
Background Patients with blood cancers experience high‐intensity medical care near the end of life (EOL) and low rates of hospice use; attributes of goals of care (GOC) discussions may partly explain these outcomes. Methods By using a retrospective cohort of patients with blood cancer who received care at Dana‐Farber Cancer Institute and died in 2014, the authors assessed the potential relationship between timing, location, and the involvement of hematologic oncologists in the first GOC discussion with intensity of care near the EOL and timely hospice use. Results Among 383 patients, 39.2% had leukemia/myelodysplastic syndromes, 37.1% had lymphoma, and 23.7% had myeloma. Overall, 65.3% of patients had a documented GOC discussion. Of the first discussions, 33.2% occurred >30 days before death, 34.8% occurred in the outpatient setting, and 46.4% included a hematologic oncologist. In multivariable analyses, having the first discussion >30 days before death (odds ratio [OR], 0.37; 95% CI, 0.17‐0.81), in the outpatient setting (OR, 0.21; 95% CI, 0.09‐0.50), and having a hematologic oncologist present (OR, 0.40; 95% CI, 0.21‐0.77) were associated with lower odds of intensive care unit admission ≤30 days before death. The presence of a hematologic oncologist at the first discussion (OR, 3.07; 95% CI, 1.58‐5.96) also was associated with earlier hospice use (>3 days before death). Conclusions In this large cohort of blood cancer decedents, most initial GOC discussions occurred close to death and in the inpatient setting. When discussions were timely, outpatient, or involved hematologic oncologists, patients were less likely to experience intensive health care use near death and were more likely to enroll in hospice.Keywords
Funding Information
- National Cancer Institute
- Harvard Medical School
- National Institutes of Health (K08 CA218295)
This publication has 31 references indexed in Scilit:
- Transfusion dependence, use of hospice services, and quality of end-of-life care in leukemiaBlood, 2018
- Cancer statistics, 2018CA: A Cancer Journal for Clinicians, 2018
- Hospice Use Among Patients With Lymphoma: Impact of Disease Aggressiveness and CurabilityJNCI Journal of the National Cancer Institute, 2015
- Hospice Admissions for Cancer in the Final Days of Life: Independent Predictors and Implications for Quality MeasuresJournal of Clinical Oncology, 2014
- Quality of end‐of‐life care in patients with hematologic malignancies: A retrospective cohort studyCancer, 2014
- Patterns of Hospice Use in Patients Dying from Hematologic MalignanciesJournal of Palliative Medicine, 2014
- Place of death in haematological malignancy: variations by disease sub-type and time from diagnosis to deathBMC Palliative Care, 2013
- Trends in the Aggressiveness of End-of-Life Cancer Care in the Universal Health Care System of Ontario, CanadaJournal of Clinical Oncology, 2011
- Determinants of Aggressive End-of-Life Care for Taiwanese Cancer Decedents, 2001 to 2006Journal of Clinical Oncology, 2009
- Aggressiveness of Cancer Care Near the End of Life: Is It a Quality-of-Care Issue?Journal of Clinical Oncology, 2008