End-of-Life Care for Blood Cancers: A Series of Focus Groups With Hematologic Oncologists
End-of-Life Care for Blood Cancers: A Series of Focus Groups With Hematologic Oncologists
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DOI：
10.1200/jop.2014.001537
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发表时间：
2014-11-01
影响因子：
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通讯作者：
Abel, Gregory A.
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文献类型：
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作者：
Odejide, Oreofe O.;Coronado, Diana Y. Salas;Abel, Gregory A.
目的：血液系统癌症与积极的癌症导向护理、濒死和临终关怀及姑息治疗服务利用不足有关。我们试图探索血液肿瘤学家的观点和决策过程中关于结束的生命（EOL）care.Methods：2013年9月至2014年1月，20血液肿瘤学家从丹娜-法伯/哈佛癌症中心参加了四个焦点小组关于白血病，淋巴瘤，多发性骨髓瘤和造血干细胞移植的EOL护理。焦点小组采用了半结构化的格式与情况下的小插曲和开放式的问题，并随后由thematic analysis.Results：许多参与者认为，确定血液系统癌症患者的EOL阶段是具有挑战性的，作为一个结果，持续的潜力治愈晚期疾病和往往快速下降临近死亡。据报告，该困难导致延迟开始EOL治疗。据报告，高质量EOL护理的障碍也是多因素的，包括医生和患者不切实际的期望，长期的医患关系导致难以进行EOL讨论，以及现有的家庭EOL服务不足。与会者还表示关注，一些实体瘤的EOL质量措施可能是不可接受的血液癌症患者给予他们独特的需求在EOL（如姑息性输血）。结论：我们的分析表明，血液肿瘤学家需要更好的临床标志物时，启动EOL护理。此外，目前的质量措施可能不适合识别血癌患者的过度积极护理。需要进一步的研究来开发有效的干预措施，以改善该患者人群的EOL护理。
Purpose: Hematologic cancers are associated with aggressive cancer-directed care near death and underuse of hospice and palliative care services. We sought to explore hematologic oncologists' perspectives and decision-making processes regarding end-of-life (EOL) care.Methods: Between September 2013 and January 2014, 20 hematologic oncologists from the Dana-Farber/Harvard Cancer Center participated in four focus groups regarding EOL care for leukemia, lymphoma, multiple myeloma, and hematopoietic stem-cell transplantation. Focus groups employed a semistructured format with case vignettes and open-ended questions and were followed by thematic analysis.Results: Many participants felt that identifying the EOL phase for patients with hematologic cancers was challenging as a result of the continuing potential for cure with advanced disease and the often rapid pace of decline near death. This difficulty was reported to result in later initiation of EOL care. Barriers to high-quality EOL care were also reported to be multifactorial, including unrealistic expectations from both physicians and patients, long-term patient-physician relationships resulting in difficulty conducting EOL discussions, and inadequacy of existing home-based EOL services. Participants also expressed concern that some EOL quality measures developed for solid tumors may be unacceptable for patients with blood cancers given their unique needs at the EOL (eg, palliative transfusions).Conclusion: Our analysis suggests that hematologic oncologists need better clinical markers for when to initiate EOL care. In addition, current quality measures may be inappropriate for identifying overly aggressive care for patients with blood cancers. Further research is needed to develop effective interventions to improve EOL care for this patient population.