This article was auto-translated from Italian. The original version, by Martina Barbaro, is available on the GIMEMA website at the following link: https://www.gimema.it/fine-vita-tumori-sangue-cosa-pensano-davvero-ematologi-cosa-serve-migliorare/
A GIMEMA survey, whose results were published in Annals of Hematology, examined the approach of Italian hematologists to end-of-life care measures in patients with hematologic cancers. Specialists agree on the interventions to be implemented, but there is a need for better training in physician–patient communication.
In hematologic cancers, end-of-life treatments are often aggressive: chemotherapy in the last weeks of life, repeated emergency department visits, intensive care unit admissions, and in-hospital deaths. A recent article published by Italian researchers in the journal Annals of Hematology, based on an online GIMEMA questionnaire, explored the attitudes of a cohort of Italian hematologists toward quality measures in end-of-life care, their views on barriers to their implementation, and potential interventions to improve them. A total of 186 Italian hematologists participated in the survey.
Hematologists rated 8 out of 13 end-of-life care quality measures as highly acceptable, including: no new chemotherapy, no intensive care unit admission, no intubation/cardiopulmonary resuscitation in the last 30 days of life, and hospice admission for more than 7 days before death.
Among the less acceptable measures are transfusions and chemotherapy in the final weeks of life, which many clinicians perceive as inappropriate interventions. The effect of seniority is noteworthy: more experienced physicians more often agree on not initiating chemotherapy in the last 14 days of life, suggesting that experience shifts practice toward de-intensification. Home care, on the other hand, is considered an excellent tool, but one third of clinicians believe it does not fully meet the needs of onco-hematologic patients, highlighting the need for a stronger home care network.
If the measures are largely shared, what has been shown to be a limitation is the relational and communicative aspect.
The most frequently cited barriers are unrealistic patient expectations (90%), physicians’ fear of taking away hope (80%), and uncertainty about “what to say and how to say it” (60%). Consistently, 73–74% report limited familiarity with conversations about care goals and shared care planning: many discuss prognosis and therapeutic priorities late, in an episodic and unstructured way, favouring the framework of curability over that of incurability.
This highlights the importance of structured training in communication skills in hematology, where the main issue is not the ethics of decisions but the language through which consensus and realistic hope are built. It has been shown that training interventions and communication quality improvement are associated with an increase in the frequency and quality of end-of-life care conversations and, most importantly, increase the likelihood that patients receive end-of-life care aligned with their preferences, with conversations focused on the patient, on understanding of the disease, and on preferences regarding palliative treatments.
Italian hematologists therefore appear aligned regarding most current end-of-life care measures, are able to identify potential critical issues, and are open and receptive to improvement interventions. However, in order to improve end-of-life care for onco-hematologic patients, a need has emerged for better training of clinicians in physician–patient communication, as well as the need to integrate an early supportive and palliative care network into treatment.
The original article by Potenza L. et al., “Understanding challenges and barriers to quality end-of-life care for patients with hematologic malignancies: a GIMEMA survey”, published in Annals of Hematology, is available at the following link: https://pubmed.ncbi.nlm.nih.gov/41068303/