Timeliness of end-of-life (EOL) discussions for blood cancers: A national survey of hematologic oncologists.

Abstract

13 Background: Although timely EOL discussions have been shown to positively impact EOL care for patients with advanced solid tumors, little is known about EOL discussions for patients with blood cancers. Methods: In 2014, we mailed a 30-item survey to a national sample of hematologic oncologists randomly selected from the American Society of Hematology clinical directory. The survey was developed through focus groups (n=20) and cognitive debriefing (n=5) with hematologic oncologists. We report preliminary data regarding timing of EOL discussions. Results: We received 349 surveys from 48 states (response rate: 57.3%). Median age was 52 years, median time in practice was 25 years, and 43% practiced primarily in tertiary centers. Of all respondents, 56% reported that EOL discussions with blood cancer patients typically occur “too late.” The great majority also reported conducting initialdiscussions regarding resuscitation status, desire for hospice care, and preferred site of death at times other than periods of disease stability (Table). In multivariable analysis adjusting for gender, years in practice, and self-reported confidence leading EOL discussions, respondents practicing in tertiary centers were more likely to report that such discussions occur “too late” (OR=1.91, 95% CI [1.22, 2.98]). Similarly, hematologic oncologists practicing in tertiary centers were less likely to report conducting timely initial resuscitation status discussions (before acute hospitalization or before death clearly imminent, OR=0.52, 95% CI [0.33, 0.82]). Conclusions: The majority of hematologic oncologists in our large national cohort reported late EOL discussions. Moreover, clinicians in tertiary centers were more likely to report late discussions, even when prompted about specific EOL topics. Our data suggest that physician-focused interventions to improve timing of EOL discussions for blood cancers should target those practicing in tertiary centers. [Table: see text]