Date of Award

Spring 2021

Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Amy Hite;

Second Advisor

Greg Belcher;

Third Advisor

Jennifer Harris;


BACKGROUND: The distorted association of “end of life (EOL)” with “goals of care (GOC)” has “silenced” crucial goals discussions in patients with relapsed high-risk leukemia, which raises concerns for the provision of care that is inconsistent with patient’s values and preferences.

AIM: The two main goals of this study were to quantify hematologists rate of participation in a GOC pathway initiative during two separate months, then explore their definition and barriers to having/documenting GOC discussions.

DESIGN: Mixed-methods, explanatory sequential design (follow-up explanations variant).

SAMPLE: Quan: Hematology inpatient admissions during the months of October 2020 and January 2021. Qual: Eighteen leukemia hematologists from one dedicated cancer in the United States.

RESULTS: During the two months, an average of 36% of admissions met criteria for GOC pathway initiation, 19% of those had an appropriate initiation order, of which 15.5% had a properly documented and billed GOC discussion. Nine hematologists responded to the SurveyMonkey with two questions. All nine included clinical situation and communication in their definition/components of GOC discussions. Time required and prognostic uncertainty were the two most mentioned barriers.