End-of-Life Care on Oncohematological Disease: Challenges and Management Strategies

ABSTRACT

Introduction:  End-of-life care is part of exclusive palliative care, consisting of actions conducted by a multidisciplinary team aimed at patients in the active dying process. For oncohematological patients, such care is essential to ensure quality of life throughout the course of the disease and in its terminal phase.

Objective:  To discuss the criteria for identifying oncohematological patients in end-of-life care.

Method:  A qualitative and descriptive study conducted between August and October 2024 in a federal oncology hospital. Two focus groups were held with 15 professionals working in oncohematology.

Results:  Two categories emerged: "Barriers to identifying patients in the active dying process/end-of-life care" and "Criteria for characterizing patients in end-of-life care." A lack of consensus was observed among participants regarding exclusive palliative care and end-of-life care. Professionals reported limited knowledge on the subject, insufficient human resources, and a lack of preparation to provide end-of-life care. Clinical and laboratory criteria were identified for characterizing patients in this stage. The creation of an algorithm was suggested to support shared decision-making.

Conclusion:  Healthcare teams face structural, political, and personal barriers in implementing end-of-life care for oncohematological patients, resulting in prolonged suffering due to the lack of early identification and integration of palliative care. Prognostic evaluation in hematology is challenging, and tools such as algorithms may assist in decision-making. Further studies are needed to validate these criteria and expand the discussion, aiming for comprehensive care that promotes quality of life and death.

Key words:
Hematological Neoplasms; Palliative Care; Patient Care Team; Terminal Care