title: Barriers to Quality End-of-Life Care for Patients With Blood Cancers.
abstract: Patients with blood cancers have been shown to receive suboptimal care at the end of life (EOL) when assessed with standard oncology quality measures (eg, no chemotherapy ≤ 14 days before death). As they were developed primarily for solid tumors, it is unclear if these measures are appropriate for patients with hematologic malignancies. Moreover, barriers to high-quality EOL care for this specific patient population are largely unknown.
  
  
  
  In 2015, we asked a national cohort of hematologic oncologists about the acceptability of eight standard EOL quality measures. Building on prior qualitative work, we prespecified that measures achieving agreement among at least 55% of respondents would be considered acceptable. We also explored perspectives regarding barriers to quality EOL care.
  
  
  
  We received 349 surveys (response rate = 57.3%). Six of the standard measures met the threshold of acceptability, and four were acceptable to > 75% of respondents: hospice admission > 7 days before death, no chemotherapy ≤ 14 days before death, no intubation in the last 30 days of life, and no cardiopulmonary resuscitation in the last 30 days of life. The highest-ranked barriers to quality EOL care reported were "unrealistic patient expectations" (97.3%), "clinician concern about taking away hope" (71.3%), and "unrealistic clinician expectations" (59.0%).
  
  
  
  In this large national cohort of hematologic oncologists, standard EOL quality measures were highly acceptable. The top barrier to quality EOL care reported was unrealistic patient expectations, which may be best addressed with more timely and effective advance care discussions.
authors.affiliation: Oreofe O. Odejide, Angel M. Cronin, Nolan B. Condron, Sean A. Fletcher, James A. Tulsky, Gregory A. Abel, Dana-Farber Cancer Institute; James A. Tulsky, Brigham and Women's Hospital, Boston, MA; and Craig C. Earle, Ontario Institute for Cancer Research, Toronto, Ontario, Canada. oreofe_odejide@dfci.harvard.edu.
authors.forename: Oreofe O
authors.initials: OO
authors.lastname: Odejide
authors.affiliation: Oreofe O. Odejide, Angel M. Cronin, Nolan B. Condron, Sean A. Fletcher, James A. Tulsky, Gregory A. Abel, Dana-Farber Cancer Institute; James A. Tulsky, Brigham and Women's Hospital, Boston, MA; and Craig C. Earle, Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
authors.forename: Angel M
authors.initials: AM
authors.lastname: Cronin
authors.affiliation: Oreofe O. Odejide, Angel M. Cronin, Nolan B. Condron, Sean A. Fletcher, James A. Tulsky, Gregory A. Abel, Dana-Farber Cancer Institute; James A. Tulsky, Brigham and Women's Hospital, Boston, MA; and Craig C. Earle, Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
authors.forename: Nolan B
authors.initials: NB
authors.lastname: Condron
authors.affiliation: Oreofe O. Odejide, Angel M. Cronin, Nolan B. Condron, Sean A. Fletcher, James A. Tulsky, Gregory A. Abel, Dana-Farber Cancer Institute; James A. Tulsky, Brigham and Women's Hospital, Boston, MA; and Craig C. Earle, Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Fletcher
authors.affiliation: Oreofe O. Odejide, Angel M. Cronin, Nolan B. Condron, Sean A. Fletcher, James A. Tulsky, Gregory A. Abel, Dana-Farber Cancer Institute; James A. Tulsky, Brigham and Women's Hospital, Boston, MA; and Craig C. Earle, Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.affiliation: Oreofe O. Odejide, Angel M. Cronin, Nolan B. Condron, Sean A. Fletcher, James A. Tulsky, Gregory A. Abel, Dana-Farber Cancer Institute; James A. Tulsky, Brigham and Women's Hospital, Boston, MA; and Craig C. Earle, Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.affiliation: Oreofe O. Odejide, Angel M. Cronin, Nolan B. Condron, Sean A. Fletcher, James A. Tulsky, Gregory A. Abel, Dana-Farber Cancer Institute; James A. Tulsky, Brigham and Women's Hospital, Boston, MA; and Craig C. Earle, Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Abel
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000592:standards; D003142:Communication; D004334:Drug Administration Schedule; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards*; D019337:Hematologic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D065026:Hope; D017051:Hospice Care / Q000592:standards; D006801:Humans; D007442:Intubation, Intratracheal / Q000592:standards; D008297:Male; D000072103:Oncologists / Q000523:psychology / Q000592:standards*; D010361:Patients / Q000523:psychology; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards*; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents