Perspectives on advance care planning for patients with hematologic malignancies : an international clinician questionnaire

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SPRING, Jenna | MCKINLAY, Jerrad | PUXTY, Kathryn | METAXA, Victoria | DETSKY, Michael | MEHTA, Sangeeta | THYAGU, Santhosh | MCGUIGAN, Kelly | MUNSHI, Laveena

BACKGROUND: Critical illness is common in hematological malignancy (HM) patients. Advance care planning (ACP) can allow these patients to express their care preferences prior to life-threatening illnesses. The objective of this study was to evaluate physicians' perspectives surrounding ACP in HM patients. METHODS: We administered a survey to intensivists and hematologic oncologists who care for patients with HM across Canada and the United Kingdom. Potential respondents were identified from institutions that have a hematologic oncology program. The survey was disseminated electronically. RESULTS: 111 physicians completed the survey with a response rate of 19% (39% across those who opened the email); 52% of respondents were intensivists and 48% hematologic oncologists. 15.5% of physicians reported that ACP happens routinely at their institution, while 8.3% of physicians stated that code status is routinely discussed. ACP discussions were most commonly reported at the onset of critical illness (84.3% of respondents), during disease recurrence (52.9% of respondents), or during transition to a strictly palliative approach (54.9% of respondents). Commonly cited barriers to ACP centred on physicians' concern about the reaction of the patient or family. CONCLUSION: This study emphasizes the need for earlier and more frequent ACP discussions in this high-risk population with a variety of barriers identified.

http://dx.doi.org/10.1513/AnnalsATS.202006-678OC

Voir la revue «Annals of the American Thoracic Society»

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