Intensivist and Hematologist Perceptions of Prognosis of Critically Ill Patients with Hematologic Malignancies

ObjectivesHistorically, patients with hematologic malignancies were often declined ICU admission due to anticipated poor outcomes. However, recent publications describe significant improvements in ICU and in-hospital mortality for critically ill patients with hematologic malignancies. It is unclear whether clinicians' perceptions of outcomes in this patient population have changed, or whether there is consensus on management. This study evaluated intensivist and hematologist perceptions of prognosis in critically ill patients with hematologic malignancies and identified factors that inform their decision-making.DesignWe conducted an electronic cross-sectional survey of Canadian intensivists and hematologists. The survey included 19 questions and a case-based scenario with variations in clinical factors. The survey data were summarized using frequency with percent. Data was compared between intensivists and hematologists using χ² tests for categorical data. A post-hoc analysis of secondary variables was also conducted using χ² tests.ResultsA total of 180 clinicians responded to the survey - 63% were intensivists, 36% hematologists and 1% dually trained. Most clinicians reported using a variety of cancer-, patient- and critical illness-related factors for prognostication, and most demonstrated awareness of factors associated with worse prognosis in this patient population. When presented with a hypothetical case, survey results revealed consensus on admitting the patient to ICU but variability in limitations to treatment and goals of care. Additionally, we found wide variability in predicted patient outcomes. There was significant variability in decision-making around withdrawal of life sustaining therapies, but minimal between-group differences between intensivist and hematologist responses.ConclusionsThis study found significant variation among clinicians in predicting prognosis for critically ill patients with hematologic malignancies, although concordance between intensivists and hematologists overall. Further study examining factors affecting prognosis and long-term outcomes for this patient population will help guide clinicians and better inform decisions about medical care.