A Trajectory-Adaptive Model of Early Palliative Care in AML and High-Risk MDS: Real-World Evidence on Core Components and Care Outcomes.

Abstract

Early palliative care (EPC) improves patient-centered outcomes in solid tumors but remain underutilized in acute myeloid leukemia (AML), where evidence on EPC content and implementation is limited. We aimed to characterize the core components...associations with palliative care quality indicators and end-of-life (EOL) care intensity. We conducted a single-center retrospective observational study including consecutive adults with AML/HR-MDS receiving outpatient EPC. We reviewed electronic medical records to identify EPC components across all visits. We assessed temporal trends by comparing the first versus last three visits. Mixed-effects logistic regression examined associations between EPC components and quality indicators; univariate models assessed associations with EOL care aggressiveness. A total of 180 patients received 1175 EPC visits (median six visits/patient). EPC components most frequently addressed symptoms (89.9%), coping support (74.6%), and illness understanding (71.2%). Over time, EOL planning increased (11.0% in first vs. 68.3% in last three visits; P < 0.001), as did family engagement (45.2% vs. 61.9%; P = 0.025). In multivariable models, more illness-understanding visits increased prognostic awareness discussions (OR 1.34; 95% CI: 1.16-1.55; P < 0.001), whereas coping-focused visits were associated with lower odds of documented goals-of-care conversations (OR 0.86; 95% CI: 0.78-0.96; P = 0.006). More EOL planning-focused visits increased the likelihood of receiving ≥1 quality indicator (OR 1.65; 95% CI: 1.40-1.94; P < 0.001) and ACP documentation (OR 2.91; 95% CI: 2.25-3.76; P < 0.001). Higher EPC exposure was associated with lower chemotherapy use in the last 30 days of life (OR 0.73; 95% CI: 0.53-1.00; P = 0.049), and coping-focused visits were associated with lower odds of in-hospital death (OR 0.77; 95% CI: 0.60-0.94; P = 0.010). EPC in AML/HR-MDS has distinct components that vary over time and are associated with established indicators of high-quality care, including EOL outcomes. These findings support a scalable, content-driven EPC model with direct implications for clinical implementation and future trials in hematologic malignancies.