Hematologic Oncologists Surveyed on Quality Measures of End-of-Life Care and Barriers to Such Care

Key Points

  • End-of-life measures supported by > 75% of clinicians surveyed were hospice admission > 7 days before death, no chemotherapy within 14 days before death, and no intubation and no cardiopulmonary resuscitation in the last 30 days of life.
  • The most frequently cited barriers were “unrealistic patient expectations,” “clinician concern about taking away hope,” and “unrealistic clinician expectations.”

In a study reported in the Journal of Clinical Oncology, Odejide et al surveyed hematologic oncologists to identify acceptable end-of-life-care quality measures and asked the clinician to identify barriers to such care. Respondents considered unrealistic patient expectations the top barrier to quality end-of-life care.

Study Details

The study involved a survey of a national cohort of physicians regarding the acceptability of eight standard oncology end-of-life-care quality measures and potential barriers to quality care. Overall acceptability was defined as agreement among 55% of respondents on acceptability of an individual measure.

Acceptable Measures

Overall, 349 surveys were completed (57% response rate). The measures meeting the threshold for acceptability consisted of no intensive care unit admission within last 30 days of life (64%), not dying in an acute facility (63%), hospice admission > 7 days before death (78%), no chemotherapy within 14 days before death (80%), no intubation in the last 30 days of life (81%), and no cardiopulmonary resuscitation in the last 30 days of life (85%). Measures not meeting the threshold were no more than 1 hospitalization within 30 days of death (54%) and no more than 1 emergency department visit within 30 days of death (54%).

Identified Barriers

The highest ranked barriers to quality end-of-life care were “unrealistic patient expectations” (97%), “clinician concern about taking away hope” (71%), “unrealistic clinician expectations” (59%), “clinician uncertainty about prognosis” (59%), and “lack of clinician time” (53%).

The investigators concluded: “In this large national cohort of hematologic oncologists, standard [end-of-life] quality measures were highly acceptable. The top barrier to quality [end-of-life] care reported was unrealistic patient expectations, which may be best addressed with more timely and effective advance care discussions.”

The study was supported in part by awards from the Lymphoma Research Foundation and the Conquer Cancer Foundation.

Oreofe O. Odejide, MD, MPH, of Dana-Farber Cancer Institute, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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