Hematologists Often Initiate End-of-Life Discussions Too Late
Respondents in tertiary care centers more likely to report late discussions versus community centers
MONDAY, Dec. 21, 2015 (HealthDay News) -- U.S. hematologists frequently report that the timing of end of life (EOL) discussions is "too late," according to a study published online Dec. 21 in JAMA Internal Medicine.
Oreofe O. Odejide, M.D., from the Dana-Faber Cancer Institute in Boston, and colleagues conducted a postal survey of U.S. hematologists who provide direct care for adult patients with hematologic cancers from Sept. 16, 2014, through Jan. 21, 2015. The authors examined the timing of EOL discussions in a series of questions.
The researchers found that 55.9 percent of the 345 individuals who answered the question about typical timing of EOL discussions reported that these discussions occurred "too late," in their experience. Compared with respondents in community centers, respondents in tertiary centers were more likely to report late EOL discussions (64.9 versus 48.7 percent; P = 0.003); this correlation persisted after multivariable adjustment. Overall, 42.5 percent of respondents reported conducting their first conversation about resuscitation status at less optimal times, while 23.2 and 39.3 percent, respectively, reported conducting an initial conversation about hospice care or preferred site of death when death was clearly imminent.
"These findings suggest the need for physician-targeted interventions for improving the timeliness of EOL discussions, especially for patients with hematologic cancers treated in tertiary settings," the authors write.