Barriers to end-of-life discussions among hematologists: A qualitative study

Background: Integrated palliative care is correlated with earlier end-of-life discussion and improved quality of life. Patients with haematological malignancies are far less likely to receive care from specialist palliative or hospice services compared to other cancers. Aim: The main goal of this study was to determine hematologists’ barriers to end-of-life discussions when potentially fatal hematological malignancies recur. Design: Qualitative grounded theory study using individual interviews. Setting/participants: Hematologists (n = 10) from four hematology units were asked about their relationships with their patients and their attitudes toward prognosis and end-of-life discussions at the time of recurrence. Results: As long as there are potential treatments, hematologists fear that end-of-life discussions may undermine their relationship and the patient’s trust. Because of their own representations, hematologists have great difficulty opening up to their patients’ end-oflife wishes. When prognosis is uncertain, negative outcome, that is, death, is not fully anticipated. Persistent hope silences the threat of death. Conclusion: This study reveals some of the barriers clinicians face in initiating early discussion about palliative care or patients’ endof- life care plan. These difficulties may explain why early palliative care is little integrated into the hematology care model

A Physician's Guide to Talking About End-of-Life Care

A large majority of patients and close family members are interested in discussing end-of-life issues with their physician. Most expect their physician to initiate such dialogue. End-of-life discussions, however, must go beyond the narrow focus of resuscitation. Instead, such discussions should address the broad array of concerns shared by most dying patients and families: fears about dying, understanding prognosis, achieving important end-of-life goals, and attending to physical needs. Good communication can facilitate the development of a comprehensive treatment plan that is medically sound and concordant with the patient's wishes and values. This paper presents a practical 4-step approach to conducting end-of-life discussions with patients and their families: (1) Initiating Discussion, (2) Clarifying Prognosis, (3) Identifying End-of-Life Goals, and (4) Developing a Treatment Plan. By following these 4 steps, communication can be enhanced, fears allayed, pain and suffering minimized, and most end-of-life issues resolved comfortably, without conflict