Table 2.

Barriers to a good death for patients with blood cancers

Hematologic oncologist–related barriers

- Discomfort with end-of-life care

- Misperceptions regarding palliative care

- Concerns that goals of care discussions will take away patients’ hope

- Not knowing the right thing to say for goals of care discussions

Patient-/caregiver-related barriers

- Misperceptions regarding prognosis

- Caregiver stress and burden

- Inadequate resources available to support caregivers

Disease-related barriers

- High prognostic uncertainty

- Rapidity of decline near the end of life

- Unpredictable disease trajectory

System-related barriers

- Limited availability of specialty palliative care programs

- Lack of access to palliative transfusions in hospice settings

- Restrictive payment models for hospice care