Improving the Transition to Palliative Care for Patients With Acute Leukemia: A Coordinated Care Approach

Currently, there is little guidance available for documenting and executing the change in management goals in the context of incurable hematologic disease.

The aim of this study was to improve the transition to palliative care for patients with acute myeloid leukemia (AML) through the development and implementation of a coordinated care plan program.

Twenty-three patients with AML who were no longer being treated with curative intent from March 2011 through September 2012 had hematology supportive care plans developed. Patients (n = 7) completed post-care plan implementation questionnaires to determine their level of understanding in relation to the change in treatment intent. Staff completed pre- (n = 26) and post- (n = 19) care plan implementation questionnaires to determine the communication, challenges, and accessibility of changed management goals.

Seventy-seven percent of patients understood palliative care to be the primary team managing their symptoms, with 75% of patients viewing symptom control as the main goal of treatment. Staff findings demonstrated a significant improvement in the communication of treatment goals (53% preimplementation vs 86% postimplementation). Early timing of referrals remains a significant issue.

Implementing the individualized care plan program was associated with better communication and accessibility of documented palliative treatment goals for patients with AML.

This study establishes a model of care that addresses symptom and disease burden in end-stage AML and provides valuable insight into the patient and family understanding of treatment intent during this terminal phase.