End-of-Life Care in Hematology/Oncology Fellowship

Abstract

Introduction: Aggressive end-of-life (EOL) care for cancer patients can lead to increased hospitalizations and worse quality of death, while goals of care (GOC) discussions including EOL care conversations are associated with fewer hospitalizations and increased hospice use. During hematology-oncology training, fellows should develop communication skills that include eliciting and documenting patients' GOC to provide quality care during EOL. We aimed to determine the frequency of documentation of GOC discussions in fellow's clinics as well as characteristics of EOL care. Methods: This study was conducted at an academic cancer center where year 1-3 fellows retrospectively reviewed patient medical records from July 2016 to June 2017 to identify patient deaths and collect information on hospitalizations, treatment, and place of death to analyze relationships with GOC discussions. Results: Out of 103 patient deaths, 48 (47%) had documented GOC discussions, 69 (67%) patients were enrolled on hospice, and 20 (19%) had an advance directive. GOC discussions were associated with higher hospice enrollment and advance directive documentation and lower hospitalizations. Conclusions: All fellows had at least one patient who died in their patient panels, but less than half of patients had documented GOC discussions. Fellowship programs should consider incorporating quality improvement measures and communication skills training to ensure fellows have competence in GOC communication and EOL care delivery.

Keywords: end-of-life care discussion; goals of care; hematology–oncology fellowship; palliative care education.