Special considerations for haematology patients in relation to end-of-life care: Australian findings

Abstract

Recent hematology clinical guidelines recommend that palliative care specialists should have central roles in hemato-oncology teams. However, the available research evidence indicates there are presently significant obstacles to the integration of palliative care in hematology. The following discussion presents findings from an Australian study designed to address the problems associated with lack of referral of hematology patients to the palliative system through the development of a best-practice model for end-of-life care for these diagnostic groups. The preliminary step in the development of such a model is to document the factors that denote the special characteristics of the end-of-life stage of hematological conditions and their treatments. This article presents the list of special considerations from a nursing perspective, including issues associated with the high-tech nature of treatments, the speed of change to a terminal event, the need for blood products and possibility of catastrophic bleeds, the therapeutic optimism based on a myriad of treatment options and the clinical indices of the terminal trajectory. The nursing insights provide an important foundation for building a practical, patient-centred model for terminal care in hematology.

Hospice Admissions for Cancer in the Final Days of Life: Independent Predictors and Implications for Quality Measures

“…24,25 This makes it difficult to identify natural transitions to palliative goals of care. 26,27 In addition to these three primary findings, several other patient characteristics were identified that were independently associated with late hospice enrollment. These include male sex, comorbidities, and nonwhite ethnicity.…”

Haematological malignancy: are patients appropriately referred for specialist palliative and hospice care? A systematic review and meta-analysis of published data

“…This is due to the nature of complications (sepsis and bleeding), variable treatment responses, the number of salvage therapies, unknown time to relapse, and not knowing which relapse will be the last. 45 Complications can also lead to the unexpectedly rapid deterioration in the patient's condition, 44,46 resulting in the transition occurring in a matter of hours. 47 This situation may mean that there is insufficient time for referral to palliative care or hospice services.…”

Catastrophic bleeds during end-of-life care in haematology: controversies from Australian research

“…This objective has been achieved and the model developed is available both as a professional booklet [10] and in the peerreview literature [8,9,11,12]. The data from the study is rich and diverse covering a wealth of topics related to endof-life care in haematology.…”