RPD103 - Characterizing Palliative Care Culture in Leukemia Care: Clinician Perspectives from 20 Hospitals

Key Message : A cross-sectional survey of leukemia and specialty palliative care (PC) clinicians across 20 hospitals assessed attitudes and perceptions of PC culture in leukemia care. Both groups recognized the value of PC for patients with AML but differed in perceptions of responsibility for PC delivery, peer norms, and leadership commitment.

Abstract: Introduction
Specialty palliative care (PC) improves quality of life for patients with acute myeloid leukemia (AML) (1). However, an insufficient number of PC clinicians limits dissemination of this model (2). An alternative strategy is training oncology clinicians to deliver “primary PC.” While previous studies involved implementation of primary PC (3,4), clinician perspectives on institutional culture related to PC remain unclear.
Methods
From February to November 2024, we administered a cross-sectional survey to leukemia and specialty PC clinicians across 20 hospitals participating in a clinical trial of specialty versus primary PC for hospitalized patients with AML. The survey assessed attitudes, peer norms, and perceptions of oncology leadership engagement regarding PC. We analyzed responses descriptively and compared specialties using chi-square tests.
Results
A total of 440 clinicians responded (189 leukemia (40% response), 251 PC (52% response)). More leukemia than PC clinicians agreed that oncology teams should be experts in physical (90% vs. 77%; p=0.001) and psychological (73% vs. 56%; p=0.003) symptom management and coordinate care throughout all stages of AML, including end-of-life (74% vs. 54%; p< 0.001). Nearly all clinicians across both specialties agreed that PC helps relieve symptoms (98% each group) and helps patients and caregivers cope (97% each group). However, more leukemia than PC clinicians perceived that their oncology peers were open to integrating PC (72% vs. 42%; p< 0.001), agreed on the importance of PC (80% vs. 39%; p< 0.001), and that oncology leadership was committed to PC (68% vs. 38%; p< 0.001).
Conclusions
Although clinicians in both groups recognized the value of PC for patients with AML, they differed in perceptions of responsibility for PC delivery, peer support, and leadership commitment. Perceived differences between oncology and PC teams may pose barriers to implementing PC interventions in this population. Future research will examine attitudes toward PC culture over time.

References: (1) El-Jawahri A, LeBlanc TW, Kavanaugh A, et al. Effectiveness of integrated palliative and oncology care for patients with acute myeloid leukemia: A randomized clinical trial. JAMA Oncol. 2021 Feb 1;7(2):238–45.
(2) Hui D, Elsayem A, De la Cruz M, Berger A, et al. Availability and integration of palliative care at US cancer centers. JAMA. 2010 Mar 17;303(11):1054–61.
(3) Bernacki R, Paladino J, Neville BA, et al. Effect of the serious illness care program in outpatient oncology: A cluster randomized clinical trial. JAMA Intern Med. 2019 Jun 1;179(6):751–9.
(4) Paladino J, Bernacki R, Neville BA, et al. Evaluating an Intervention to Improve Communication Between Oncology Clinicians and Patients With Life-Limiting Cancer: A Cluster Randomized Clinical Trial of the Serious Illness Care Program. JAMA Oncol. 2019 Jun 1;5(6):801–9.