Haematologists' perceptions about end-of-life discussion: A qualitative study

Objectives. - Haematological patients have half as much access to palliative care than their counterparts with solid malignancies. Having an early end-of-life discussion with patients is linked to better palliative care for patients with cancers. The main objective of the study was to understand what makes an end-of-life discussion easy or difficult at the time of relapse of an aggressive haematologic malignancy, according to oncohaematologists. The side issue was to explore the consequences of such discussions on integration of palliative care in haematology. Methods. - This article presents ten semi-structured, in-depth interviews of French-speaking haematologists. Verbatim transcribed from the interviews were thematically analysed according to the grounded theory model. Results. - At the time of relapse, the possibility of an end-of-life discussion was subordinated to the fear of loss of therapeutic alliance. Haematologists had a lot of difficulty opening up to the patients' subjectivity and to take one stand facing their progress in a therapeutic context. The anticipation of bad prognosis was not exploited in a doubtful situation. Communication centered on hope has been preferred to approach the question of death, seen as a threat. Conclusion. - The consideration of clinicians' subjectivity in the complexity of end-of-life discussions brings up the question of advanced care, narrative medicine and the third parties in order to integrate the early palliative care in haematology model. (C) 2017 Elsevier Masson SAS. All rights reserved.