Palliative care service incorporated in a hematology department: a working model fostering changes in clinical practice

A qualitative evidence synthesis of healthcare professionals’ experiences and views of palliative care for patients with a haematological malignancy

“…haematologists have expressed concern that hospice care could not meet the needs of patients because of their transfusion needs (McCaughan et al, 2018a;Odejide et al, 2014;Wright & Forbes, 2017). Moreover, when patients need multiple blood and platelet transfusions requiring frequent visits to hospital, haematologists may be reluctant to hand over the care to palliative care (Ofran et al, 2019). While new models of hospice that accommodate transfusion and continuing input from the haematology team are needed (Odejide et al, 2017), there is also a need for clinical guidelines on antibiotic and transfusion use in order to standardise palliative care for patients with haematological malignancies (Cheng et al, 2015;LeBlanc, 2016).…”

“…Finally, a promising new model of care is reported by Ofran et al. (2019) where a haematology palliative care team works under the supervision of senior haematologists. The team consists of two senior haematologists, nurses from both day and inpatient units, three social workers, two psychologists and one pastoral care provider, and referrals for patient evaluations are made to the nurse coordinator who ensures that a social worker undertakes a screening interview with the patient within 48 hr.…”

“…Reporting on the model's success after four years in operation, Ofran et al. (2019) highlighted that in 2014 before its introduction, 26/42 (62%) of the patients who died in the department did do while being ventilated, and this figure dropped to 42.5% (20/47) in 2017, without any changes in department staff or treatment protocols.…”

“…Moreover, haematologists often prefer to manage palliative care themselves (LeBlanc et al., 2015; Wright & Forbes, 2017) and also delay EOL care because of unrealistic expectations that treatment may be beneficial (Button et al., 2014; Leung et al., 2012; Odejide, Salas Coronado, Watts, Wright, & Abel, 2014). Nevertheless, there is growing evidence of haematologists’ support for integrated palliative care (Cormican & Dowling, 2016; Wright & Forbes, 2017), and recent evidence illustrates the benefit of early palliative care on patients’ QoL (El‐Jawahri et al, 2016; Ofran et al, 2019).…”

Las personas con enfermedad terminal y la necesidad de cuidados paliativos: una deuda pendiente de los servicios de salud

“…La atención paliativa tiene su mayor beneficio cuando las intervenciones son tempranas, de ahí la necesidad de su desarrollo en el primer nivel de atención. Esto significa que la atención paliativa no debe circunscribirse a especialistas ni centros de alta complejidad [84] .…”