In a study reported in the Journal of Clinical Oncology, Oreofe O. Odejide, MD, MPH, of Dana-Farber Cancer Institute, and colleagues surveyed hematologic oncologists to identify acceptable end-of-life-care quality measures and barriers to such care. Respondents considered unrealistic patient expectations the top barrier to quality end-of-life care.
The study involved a survey of a national cohort of physicians regarding the acceptability of eight standard oncology end-of-life-care quality measures and potential barriers to quality care. Overall acceptability was defined as agreement among 55% of respondents on acceptability of an individual measure.
Acceptable Measures and Identified Barriers
Overall, 349 surveys were completed (57% response rate). The measures meeting the threshold for acceptability consisted of no intensive care unit admission within last 30 days of life (64%), not dying in an acute facility (63%), hospice admission > 7 days before death (78%), no chemotherapy within 14 days before death (80%), no intubation in the last 30 days of life (81%), and no cardiopulmonary resuscitation in the last 30 days of life (85%). Measures not meeting the threshold were no more than 1 hospitalization within 30 days of death (54%) and no more than 1 emergency department visit within 30 days of death (54%).
The highest ranked barriers to quality end-of-life care were “unrealistic patient expectations” (97%), “clinician concern about taking away hope” (71%), “unrealistic clinician expectations” (59%), “clinician uncertainty about prognosis” (59%), and “lack of clinician time” (53%).
The investigators concluded: “In this large national cohort of hematologic oncologists, standard [end-of-life] quality measures were highly acceptable. The top barrier to quality [end-of-life] care reported was unrealistic patient expectations, which may be best addressed with more timely and effective advance care discussions.”
The study was supported in part by awards from the Lymphoma Research Foundation and the Conquer Cancer Foundation. ■