Preferred and actual place of death in haematological malignancy

Abstract

ObjectivesHome is considered the preferred place of death for many, but patients with haematological malignancies (leukaemias, lymphomas and myeloma) die in hospital more often than those with other cancers and the reasons for this are not wholly understood. We examined preferred and actual place of death among people with these diseases.MethodsThe study is embedded within an established population-based cohort of patients with haematological malignancies. All patients diagnosed at two of the largest hospitals in the study area between May 2005 and April 2008 with acute myeloid leukaemia, diffuse large B-cell lymphoma or myeloma, who died before May 2010 were included. Data were obtained from medical records and routine linkage to national death records.Results323 deceased patients were included. A total of 142 (44%) had discussed their preferred place of death; 45.8% wanted to die at home, 28.2% in hospital, 16.9% in a hospice, 5.6% in a nursing home and 3.5% were undecided; 63.4% of these died in their preferred place. Compared to patients with evidence of a discussion, those without were twice as likely to have died within a month of diagnosis (14.8% vs 29.8%). Overall, 240 patients died in hospital; those without a discussion were significantly more likely to die in hospital than those who had (p≤0.0001). Of those dying in hospital, 90% and 75.8% received haematology clinical input in the 30 and 7 days before death, respectively, and 40.8% died in haematology areas.ConclusionsMany patients discussed their preferred place of death, but a substantial proportion did not and hospital deaths were common in this latter group. There is scope to improve practice, particularly among those dying soon after diagnosis. We found evidence that some people opted to die in hospital; the extent to which this compares with other cancers is of interest.

Timeliness of End-of-Life Discussions for Blood Cancers

“…Methods | From September 16, 2014, through January 21, 2015, we conducted a postal survey of US hematologists who provide direct care for adult patients with hematologic cancers, whom we identified from the clinical directory of the American Society of Hematology. We developed the survey instrument through a synthesis of preliminary data from a series of focus groups with hematologic oncologists, 2 a review of the relevant literature, previously published survey instruments, [3][4][5] and formal cognitive debriefing.…”

“…However, the findings are in line with surveys of program directors, medical students, and residents who all noted missed opportunities for faculty to model these skills. 4 How might educators change the culture of rounds from rewarding meticulousness to celebrating moderation? Just as we challenge trainees to explain their diagnostic reasoning, so too should we probe them to justify their use of tests and resources.…”

Home care of acute leukaemia patients: From active therapy to end‐of‐life and palliative care. The 3‐year experience of a single centre

“…Only 40.5% of patients (15/37) died in hospital, mainly due to inadequate family environment or a specific caregiver or patient request. (18) Data not available, n (%) 0/37 (0) 2/17 (11) We analysed the place of death of the 17 patients with AL assisted at home in our province from 01 July 2009 to 01 July 2012.…”

“…Moreover, many studies have reported that, given a choice, most people would prefer to die at home . It is well known that patients with haematological malignancies are more likely to die in hospital than those with other cancers or non‐malignant conditions . Physicians should pay greater attention to the patients’ perspective on time spent in hospital, and on the medical care, they receive throughout their illness and at the end of life …”

“…[4][5][6] It is well known that patients with haematological malignancies are more likely to die in hospital than those with other cancers or non-malignant conditions. [7][8][9][10][11] Physicians should pay greater attention to the patients' perspective on time spent in hospital, and on the medical care, they receive throughout their illness and at the end of life. 2 Treatment-related mortality (TRM) rates of AL patients following induction chemotherapy with curative intent have significantly decreased, 12,13 thanks mainly to the improvements in supportive care.…”