Early Palliative Care, Goals of Care Conversations and Quality EOL Care in Acute Leukemia and HR-MDS.

CONTEXT

Patients with acute leukemia frequently receive aggressive treatments near the end of life (EOL). Goals-of-care (GOC) conversations may improve EOL quality, yet few studies have investigated their impact in hematological malignancies.

OBJECTIVES

To evaluate sociodemographic and clinical factors associated with GOC conversations and the impact of GOC conversations on EOL care.

METHODS

A retrospective study was conducted among patients with acute leukemia and high-risk myelodysplastic syndromes, treated over a 15-year period at authors' Institution.

RESULTS

Of 390 patients, 44.4% had GOC conversations. Palliative care specialists documented the first GOC discussion in 157 patients. One hundred and thirty-three (76.9%) patients received GOC conversations within a program of early palliative care (EPC) . In multivariable analysis, age≥60 (OR: 4.85; 95% CI: 2.18-10.78), ≥2 comorbidities (OR: 2.52; 95% CI: 1.03-6.2), non-White race (OR: 7.97; 95% CI: 1.13-56.32), prior allogeneic transplantation (OR: 8.74; 95% CI: 2.09-36.58), and EPC integration (OR: 16.28; 95% CI: 4.21-62.92) were significantly associated with higher likelihood of GOC discussions. Concerning EOL care, GOC conversations were associated with reduced odds of chemotherapy in the last 90 days (OR: 0.41; 95% CI: 0.21-0.79), ICU admission in the last 30 days (OR: 0.20; 95% CI: 0.05-0.85), and in-hospital death (OR: 0.35; 95% CI: 0.18-0.69) .

CONCLUSIONS

GOC conversations were infrequently performed and the primary factor that increased their likelihood of occurrence was EPC. When GOC conversations took place, patients experienced higher-quality EOL care. These results support increasing EPC for patients with hematologic malignancies to improve GOC conversations and their overall EOL care and suggest EPC as a prime intervention for trials in this setting.