Variabilidade na percepção de cuidados paliativos e cuidados de fim de vida entre profissionais de hematologia de um mesmo centro de referência na Bahia, Brasil: um estudo de corte transversal

Abstract

Introduction: Several illness-specific cultural and system-based barriers to palliative care (PC) integration and optimal end-of-life (EOL) care exist in the oncohematology scenario. Limited research exists exploring determinants of the discrepancies in daily implementation of PC among healthcare professionals in this field. Objective: We aimed to investigate the variability in PC and EOL care among hematologists and hematology residents at the hematology service of Clinics Hospital of the Federal University of Bahia (UFBA). Methods: Cross-sectional study performed between October and December 2022. Variables were collected through a sociodemographic questionnaire and an adaptation of clinical questionnaires used in previous studies. Results: During the research period, all twenty physicians from the hematology division of the Clinics Hospital of the UFBA participated. Median age was 44 years-old, with 80% of participants identifying as female and 75% were graduated hematologists. Participants were presented with a hypothetical scenario involving the treatment of a 65-year-old female patient with poor prognosis acute myeloid leukemia refractory to first-line treatment. Sixty percent of participants chose to follow other chemotherapy regimens, while 40% implemented PC. Participants next considered a case salvage for the patient who developed septic shock following chemotherapy and were prompted to choose their most probable conduct and the conduct they thought would be better for the patient. Even though being part of the same center, we found a divergence from the most probable conduct among 40% of participants. Reasons involved personal convictions, legal aspects and other physicians’ reactions. Discussion: We found considerable differences within PC decisions between professionals despite being under the same service and protocols. Such investigations hold immense importance for existing literature, as they may identify modifiable factors that can effectively enhance quality of PC and EOL care within the oncohematology setting.