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Goal of a “Good Death” in End-of-Life Care for Patients with Hematologic Malignancies—Are We Close?

  • Health Economics (N Khera, Section Editor)
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Abstract

Purpose of Review

The medical field has a critical role not only in prolonging life but also in helping patients achieve a good death. Early studies assessing end-of-life quality indicators to capture if a good death occurred demonstrated low rates of hospice use and high rates of intensive healthcare utilization near death among patients with hematologic malignancies, raising concerns about the quality of death. In this review, we examine trends in end-of-life care for patients with hematologic malignancies to determine if we are close to the goal of a good death.

Recent Findings

Several cohort studies show that patients with blood cancers are often inadequately prepared for the dying process due to late goals of care discussions and they experience low rates of palliative and hospice care. More recent analyses of population-based data demonstrate some improvements over time, with significantly more patients receiving palliative care, enrolling in hospice, and having the opportunity to die at home compared to a decade ago. These encouraging trends are paradoxically accompanied by concomitant increases in late hospice enrollment and intensive healthcare utilization near death.

Summary

Although we are closer to the goal of a good death for patients with hematologic malignancies, there is ample room for growth. To close the gap between the current state of care and a good death, we need research that engages patients, caregivers, hematologic oncologists, and policy-makers to develop innovative interventions that improve timeliness of goals of care discussions, expand palliative care integration, and increase hospice use.

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Funding

O.O. Odejide received research support from the National Cancer Institute of the National Institutes of Health (NCI K08 CA218295).

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Authors and Affiliations

  1. Department of Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Thomas M. Kuczmarski

  2. Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Oreofe O. Odejide

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Kuczmarski, T.M., Odejide, O.O. Goal of a “Good Death” in End-of-Life Care for Patients with Hematologic Malignancies—Are We Close?. Curr Hematol Malig Rep 16, 117–125 (2021). https://doi.org/10.1007/s11899-021-00629-1

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