Code status transitions in patients with high-risk acute myeloid leukemia

Area of Science:

• Hematology
• Oncology
• Palliative Care

Background:

• High-risk acute myeloid leukemia (AML) patients often receive intensive end-of-life (EOL) care, including frequent hospitalizations and ICU admissions.
• Limited research exists on code status transitions in this population.
• Defining high-risk AML as relapsed/refractory or diagnosis at age ≥60 is crucial for understanding care patterns.

Purpose of the Study:

• To characterize code status transitions in patients with high-risk AML.
• To identify factors influencing these transitions and their timing relative to death.
• To evaluate the timing and nature of goals-of-care discussions.

Main Methods:

• A mixed-methods study involving 200 high-risk AML patients from 2014-2021.
• Consensus-driven medical record review to document code status changes.
• Analysis of conversation types preceding transitions and their association with outcomes.

Main Results:

• At diagnosis, 86% of patients were full code; 57% experienced at least one transition.
• The median time from the last transition to death was 2 days.
• Most final transitions were to comfort measures, with limited patient participation in these discussions.
• Informative conversations about futility and younger age were linked to shorter time from transition to death.

Conclusions:

• A majority of high-risk AML patients are presumed full code, with transitions often occurring late and focused on EOL care.
• Goals-of-care discussions frequently happen late in the AML disease course.
• Interventions are needed to promote earlier and more comprehensive EOL preference discussions.