Although hospice care is nationally endorsed as an indicator of high-quality end-of-life (EOL) care, only a minority of patients who die from blood cancers in the United States enroll. Indeed, it has been repeatedly shown that patients with hematologic cancers have the lowest rate of hospice use compared to other malignancies, and when they do enroll, it is often exceedingly close to death. Yet, little is known about factors that influence hospice use. Dr. Odejide's research objective is to rigorously characterize factors that influence EOL care for patients with blood cancers, with the goal of developing effective interventions for improvement. In a national survey of 349 US-based hematologic oncologists that Dr. Odejide conducted, although the vast majority agreed that hospice was helpful, almost 50% felt that the traditional model of hospice may not be adequate for the needs of patients with blood cancers (e.g. transfusions).Through this proposal, Dr. Odejide will combine what she has learned from hematologic oncologists with new data from patients with blood cancers and hospice providers to develop a blood cancer-specific hospice delivery program to promote timely hospice use.
In Aim 1, through a series of focus groups with patients with hematologic cancers, Dr. Odejide will develop a conjoint survey to characterize their EOL needs and perceptions of hospice. She will then administer this conjoint survey to a large sample of patients with hematologic cancers at two cancer centers. This will ensure that the perspectives of blood cancer patients themselves are incorporated into intervention development.
In Aim 2, she will conduct a national survey of hospice providers to identify the challenges faced caring for patients with blood cancers, and potential interventions for improvement. Finally, in Aim 3, incorporating data from her prior work with hematologic oncologists and Aims 1 and 2, she will create several candidate modified hospice delivery models. She will then engage expert stakeholders (hematologic oncologists and hospice administrators) with a modified Delphi approach to identify the most acceptable model with greatest likelihood of improving hospice use, which will be piloted with a hospice agency. This research will facilitate training in areas vital to Dr. Odejide's career goals: advanced qualitative methods, decision science, and intervention development, in which she has planned rigorous coursework. Dr. Odejide has two highly-qualified and committed mentors: Dr. Gregory Abel, one of the few expert hematology- focused health services researchers in the country, and Dr. James Tulsky, a leader in EOL care research and intervention development. In total, the proposed research and career development plan will deepen Dr. Odejide's research expertise and enable her to transition to an independent health services researcher devoted to improving quality of EOL care for patients with blood cancers.

Public Health Relevance

Approximately 58,000 individuals in the United States die from hematologic cancers each year. Although this makes high-quality end-of-life care an imperative, existing literature demonstrates that patients with hematologic malignancies have the lowest rates of timely hospice use in oncology. The proposed research will characterize factors that impact hospice use from the perspectives of patients with blood cancers and hospice providers, and use the resulting data to develop a modified hospice delivery program to promote timely enrollment and improve end-of-life care for blood cancer patients.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Clinical Investigator Award (CIA) (K08)
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Subcommittee I - Transistion to Independence (NCI)
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Ojeifo, John O
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Dana-Farber Cancer Institute
United States
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Odejide, Oreofe O; Li, Ling; Cronin, Angel M et al. (2018) Meaningful changes in end-of-life care among patients with myeloma. Haematologica 103:1380-1389