Palliative Care Physician Comfort (and Discomfort) with Discussing Prognosis in Hematologic Diseases: Results of a Nationwide Survey (SA528B)

•Recognize wide variability in palliative care physicians’ comfort in discussing prognosis of patients with hematologic diseases.•Identify common reasons why palliative care physicians feel comfortable or uncomfortable discussing prognosis in these diseases.•Discuss opportunities to improve palliative care physicians’ comfort in discussing prognosis with hematology patients. Palliative care specialists provide supportive care for patients with hematologic diseases. Prior investigations have surveyed hematologists to characterize barriers to delivery of palliative care to these patients, but palliative care physicians’ perspectives remain unclear. This research is part of a larger study aimed to examine the beliefs, comfort levels, and attitudes of palliative care physicians toward their interactions with the field of hematology. A survey was mailed to a random sample of the AAHPM physician contact list in 2017. Results were anonymized. Participants were asked about their comfort in discussing prognosis regarding hematologic malignancies. Written responses were analyzed, themes were identified, and individual topics within responses were coded in a binary fashion (ie, conveying comfort or discomfort). Four-hundred fifty-nine of 1,000 surveys included a written response. Fifty-point-eight percent of respondents were male. Community (34.9%), academic (38.5%), and hospice (26.7%) physicians were represented. In discussing prognosis of hematologic malignancies, 41.1% of responses contained only topics expressing comfort, 40.5% contained only topics expressing discomfort, 16.6% responses were mixed, and 2% were not applicable. Commonly cited explanations for comfort were training and clinical experience (47.9%), strong relationships with hematologists (37%), and clear trajectory given likely imminent death (12.8%). Nine-point-eight percent reported fellowship training in or practicing hematology as a reason for comfort. Commonly cited reasons for discomfort were lack of clinical exposure (51.9%), uncertainty of disease trajectories (22.9%), poor relationships with hematologists (17.2%), limited knowledge of hematologic diseases (13.7%), and rapidly-changing treatments (9.2%). Palliative care physicians report varying comfort in discussing prognosis in hematologic diseases. This may be a function of clinical exposure to these diseases in practice and training, as well as strong relationships with hematologists.