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

BACKGROUND:: Currently, there is little guidance available for documenting and executing the change in management goals in the context of incurable hematologic disease. OBJECTIVE:: 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. METHODS:: 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. RESULTS:: 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. CONCLUSIONS:: Implementing the individualized care plan program was associated with better communication and accessibility of documented palliative treatment goals for patients with AML. IMPLICATIONS FOR PRACTICE:: 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.