title: End-of-life care for blood cancers: a series of focus groups with hematologic oncologists.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dana-Farber Cancer Institute and University of Massachusetts Boston, Boston, MA.
authors.forename: Oreofe O
authors.initials: OO
authors.lastname: Odejide
authors.affiliation: Dana-Farber Cancer Institute and University of Massachusetts Boston, Boston, MA.
authors.forename: Diana Y
authors.initials: DY
authors.lastname: Salas Coronado
authors.affiliation: Dana-Farber Cancer Institute and University of Massachusetts Boston, Boston, MA.
authors.forename: Corey D
authors.initials: CD
authors.lastname: Watts
authors.affiliation: Dana-Farber Cancer Institute and University of Massachusetts Boston, Boston, MA.
authors.forename: Alexi A
authors.initials: AA
authors.lastname: Wright
authors.affiliation: Dana-Farber Cancer Institute and University of Massachusetts Boston, Boston, MA Gregory_abel@dfci.harvard.edu.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Abel
mesh_terms: D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D019337:Hematologic Neoplasms / Q000628:therapy*; D017051:Hospice Care; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D010360:Patient Transfer; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D013727:Terminal Care