• Chloé Prod'homme, Dominique Jacquemin, Licia Touzet, Regis Aubry, Serge Daneault, and Laurent Knoops.
• 1 ETHICS (Experiment, Transhumanism, Human Interactions, Care and Society) - EA7446, Lille Catholic University, Lille, France.
• Palliat Med. 2018 May 1; 32 (5): 1021-1029.

BackgroundIntegrated palliative care is correlated with earlier end-of-life discussion and improved quality of life. Patients with haematological malignancies are far less likely to receive care from specialist palliative or hospice services compared to other cancers.AimThe main goal of this study was to determine hematologists' barriers to end-of-life discussions when potentially fatal hematological malignancies recur.DesignQualitative grounded theory study using individual interviews.Setting/ParticipantsHematologists ( n = 10) from four hematology units were asked about their relationships with their patients and their attitudes toward prognosis and end-of-life discussions at the time of recurrence.ResultsAs long as there are potential treatments, hematologists fear that end-of-life discussions may undermine their relationship and the patient's trust. Because of their own representations, hematologists have great difficulty opening up to their patients' end-of-life wishes. When prognosis is uncertain, negative outcome, that is, death, is not fully anticipated. Persistent hope silences the threat of death.ConclusionThis study reveals some of the barriers clinicians face in initiating early discussion about palliative care or patients' end-of-life care plan. These difficulties may explain why early palliative care is little integrated into the hematology care model.

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