Management of Intensive Care Unit Admission of Patients With Blood Cancer

Abstract

BACKGROUND: Patients with blood cancer are at high risk of complications requiring intensive care. Admission to the intensive care unit (ICU) involves ethical and organizational complexities. OBJECTIVE: To investigate the perspectives of hematologists and intensivists making ICU admission decisions in France. METHODS: A nationwide survey of French hematologists and intensivists was conducted using clinical vignettes to assess ICU admission criteria. The influence of institutional practices, individual experiences, and cancer status on ICU transfer decisions was explored. RESULTS: All 174 participating physicians agreed on ICU admission for patients with immediately life-threatening conditions. Although the general principle of early ICU admission was supported by 75% of hematologists and 54% of intensivists, responses to specific clinical scenarios showed that intensivists recommended broader ICU access and earlier involvement, particularly for patients with noncritical but high-risk conditions. Hematologists more often deferred ICU discussions until clinical deterioration had occurred. Structural barriers such as lack of shared protocols, variations in training, and absence of ICU staff members in hematology decision-making contributed to inconsistent practices. Ethical guidelines were underrecognized and unevenly applied. Neither physician group routinely included nurses in discussions despite nurses' critical role in ICU care. CONCLUSIONS: In France, ICU admission practices for patients with blood cancer vary between hematologists and intensivists. Harmonizing practices through common training, early multidisciplinary discussions, risk assessment models, and improved knowledge of ethical standards is urgently needed. These findings may reflect global challenges in aligning ICU triage with evolving cancer care.