Goals of care discussions for patients with blood cancers: Association of person, place, and time with end‐of‐life care utilization. Issue 3 (8th October 2019)

• Record Type: Journal Article
• Authors: Odejide, Oreofe O.; Uno, Hajime; Murillo, Anays; Tulsky, James A.; Abel, Gregory A.
• Is Part Of: Cancer. Volume 126:Issue 3(2020)
• Page Start: 515
• Page End: 522
• Publication Date: 2019-10-08
• Subjects: blood cancers -- end‐of‐life care -- goals of care discussions -- hematologic oncologists; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.32549
• Languages: English
• ISSNs: 0008-543X

Abstract

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. Abstract : In a cohort of blood cancer decedents, most initial goals of care discussions occurred ≤30 days before death or in the inpatient setting. Discussions that were timely, outpatient, or involved hematologic oncologists were associated with lower rates of intensive health care utilization near death and with higher rates of early hospice enrollment.