The intent of treatment can be defined as one of the following:

• curative
• anti-leukaemia therapy to improve longevity and quality of life without expectation of cure
• symptom palliation including active supportive care.

The treatment intent should be documented in the patient’s medical record. Achieving a complete remission is the first goal for patients receiving either curative intent therapy or treatment designed to improve longevity and quality of life without expectation of cure.

The potential benefits need to be balanced against the morbidity and risks of treatment.

The lead clinician should discuss the advantages and disadvantages of each treatment and associated potential side effects with the patient and their carer or family before treatment consent is obtained and begins so the patient can make an informed decision. Supportive care services should also be considered during this decision-making process. Patients should be asked about their use of (current or intended) complementary therapies (see Appendix D).

Timeframes for starting treatment should be informed by evidence-based guidelines where they exist. The treatment team should recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients.

Initiate advance care planning discussions with patients before treatment begins (this could include appointing a substitute decision-maker and completing an advance care directive). Formally involving a palliative care team/service may benefit any patient, so it is important to know and respect each person’s preference (AHMAC 2011).