Improving End-of-Life Discussions for Blood Cancers
Each year, approximately 35% of patients with hematologic
malignancies in the United States die as a result of their disease. While this
makes high-quality end-of-life (EOL) care an imperative, existing literature
demonstrates higher rates of intensive EOL care and lower rates of hospice use
for patients with blood cancers. In solid tumor oncology, it has been shown
that timely EOL discussions (also known as goals of care discussions [GCD])
between patients and physicians can improve EOL care. Patients with blood
cancers are different, as they often have curable disease even when it is
advanced, and the EOL phase of disease is difficult to identify. To improve
care for patients with hematologic malignancies, both a rigorous understanding
of GCD for this patient population and successful interventions are critically
We propose to study GCD for patients with blood cancers and
develop an intervention to improve such discussions. First, we will survey
patients with hematologic cancers to characterize their information needs, and
perspectives regarding appropriate timing of GCD. Second, we will pilot a
physician-targeted intervention to promote high-quality and timely GCD for
patients with disease states that have been identified by hematologic
oncologists as suggesting that the EOL may be near. We will then assess rates
and quality of GCD, as reported by patients whose doctors have experienced the
To date, the voice of patients with blood cancers with
respect to GCD is lacking in the literature. Our study will address this gap by
capturing what is most important to patients and incorporating these findings
into our intervention. We will also provide unique data as to the feasibility
and potential impact of our intervention on quality and timeliness of GCD.
Demonstration of a positive impact would be an important step in addressing the
specific EOL needs of this understudied population.
Odejide, MD, MPH is a hematologic oncologist at the Dana-Farber Cancer
Institute, Boston, MA and an Instructor in Medicine at Harvard Medical School.
She received her medical degree from Howard University College of Medicine and
a Master of Public Health from the Harvard School of Public Health. She
completed residency training in internal medicine at Brigham and Women’s
Hospital, followed by medical oncology/hematology fellowship at the
Dana-Farber/Partners Cancer Care Program.
Dr Odejide’s research is focused on carefully characterizing factors
that impact quality of care for patients with hematologic cancers, particularly
at the end of life, with the ultimate goal of developing effective and scalable
interventions to improve care. The NPCRC Junior Faculty Career Development
Award will provide Dr. Odejide with the support needed to develop and pilot an
intervention to promote high-quality and timely end-of-life discussions for
patients with hematologic malignancies.