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Goals of care discussions for patients with blood cancers: Association of person, place, and time with end-of-life care utilization.

Authors
  • Odejide, Oreofe O1, 2
  • Uno, Hajime1
  • Murillo, Anays3
  • Tulsky, James A4, 5
  • Abel, Gregory A1, 6
  • 1 Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
  • 2 Center for Lymphoma, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
  • 3 Tufts University School of Medicine, Boston, Massachusetts.
  • 4 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
  • 5 Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
  • 6 Center for Leukemia, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Type
Published Article
Journal
Cancer
Publisher
Wiley (John Wiley & Sons)
Publication Date
Feb 01, 2020
Volume
126
Issue
3
Pages
515–522
Identifiers
DOI: 10.1002/cncr.32549
PMID: 31593321
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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). 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. © 2019 American Cancer Society.

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