ASH 2021 | Improving code status transitions in management of patients with acute myeloid leukemia (AML)

Patients with high-risk acute myeloid leukemia (AML) often have considerable misperceptions of their prognosis, which may lead to difficult code status transitions near the end of life. Hannah R. Abrams, MD, Massachusetts General Hospital, Boston, MA, presents results from a mixed-methods study of 200 patients, in which status were coded as ‘full’, ‘restricted’, or ‘comfort measures only’, with transitions taking place after pre-emptive, anticipatory or informative conversations among caregivers, with or without patients or their relatives. 57% of patients experienced a code status transition, with median time from diagnosis to first transition, and from last transition to death of 212 days and 2 days, respectively. Patients often do not participate in their code status transition, and most of them (51%) experienced a transition after acute clinical deterioration that led to withdrawal of life sustaining therapy. The study results suggest that goals of care discussions leading to code status transitions occur too late in the typical course of illness of patients with poor prognosis, high-risk AML. This press briefing was recorded at the American Society of Hematology (ASH) 2021 Annual Meeting and Exposition in Atlanta, GA.