TY - JOUR
T1 - Health-Related Values Discussions with Patients Undergoing Allogeneic and Autologous Stem Cell Transplant
T2 - Feasibility and Acceptability of an Early Primary Palliative Care Intervention
AU - Cohen, Abigail G.
AU - Cho, Christina
AU - Patterson, Emily
AU - Magaldi, Jessica
AU - Doga, Tara
AU - Naputo, Kristine
AU - Alvarez, Kelsey
AU - Giles, Elizabeth
AU - Yang, Grace
AU - Hoque, Afshana
AU - Kramer, Dana
AU - Devlin, Sean
AU - Nemirovsky, David
AU - Rosa, William E.
AU - Goldberg, Jessica I.
AU - Perales, Miguel Angel
AU - Epstein, Andrew S.
AU - Nelson, Judith E.
AU - Landau, Heather
N1 - Publisher Copyright: © 2024 The American Society for Transplantation and Cellular Therapy
PY - 2025/2
Y1 - 2025/2
N2 - Background: Hematopoietic stem cell transplant (HSCT) has curative potential but also relatively high morbidity and mortality. Patients have multidimensional palliative care (PC) needs throughout the transplant process. However, PC is not routinely offered to patients with hematologic malignancies. National guidelines recommend PC concurrent with curative hematologic disease treatment, including HSCT. Objectives: Our goal was to determine the feasibility and acceptability of incorporating early and ongoing discussions of patients’ core health-related values (HRVs) for patients with hematologic malignancies undergoing HSCT. Study Design: We designed and implemented a pilot study evaluating the transplant team's use of a brief, structured guide with eight open-ended questions to support patients’ articulation of their HRVs. All English-speaking patients undergoing HSCT from March 2021 to March 2022 in two outpatient HSCT clinics were eligible and offered enrollment. HRV discussions were planned pretransplant, and then at 5 time points post-transplant (Day 10-14, Day 30, Day 100, 6 months, 1 year). Clinicians and patients were surveyed to assess the feasibility and acceptability of this primary PC intervention. Results: 31 patients, mostly male (61%) and white (68%), with plasma cell (58%) and myeloid (42%) diseases participated in 149 values discussions. Initial discussions averaged 17.7 minutes; subsequent discussions were 13.3 minutes. Most patients were comfortable discussing their values and indicated it was important and helpful for them, as well as beneficial for their caregivers. Patients reported feeling heard and understood by their care team following values discussions. Clinicians were comfortable having the discussions, felt they were beneficial, and indicated learning new information about their patients beyond their diagnosis. Conclusions: Incorporating discussions of patients’ HRVs into routine HSCT care was found to be feasible and acceptable in this pilot study. Feedback from patients and providers was overwhelmingly positive. Based on these results, the program has been refined and expanded to include all patients receiving HSCT and chimeric antigen receptor T cell (CAR-T) therapy, with plans to study the clinical impact of this approach.
AB - Background: Hematopoietic stem cell transplant (HSCT) has curative potential but also relatively high morbidity and mortality. Patients have multidimensional palliative care (PC) needs throughout the transplant process. However, PC is not routinely offered to patients with hematologic malignancies. National guidelines recommend PC concurrent with curative hematologic disease treatment, including HSCT. Objectives: Our goal was to determine the feasibility and acceptability of incorporating early and ongoing discussions of patients’ core health-related values (HRVs) for patients with hematologic malignancies undergoing HSCT. Study Design: We designed and implemented a pilot study evaluating the transplant team's use of a brief, structured guide with eight open-ended questions to support patients’ articulation of their HRVs. All English-speaking patients undergoing HSCT from March 2021 to March 2022 in two outpatient HSCT clinics were eligible and offered enrollment. HRV discussions were planned pretransplant, and then at 5 time points post-transplant (Day 10-14, Day 30, Day 100, 6 months, 1 year). Clinicians and patients were surveyed to assess the feasibility and acceptability of this primary PC intervention. Results: 31 patients, mostly male (61%) and white (68%), with plasma cell (58%) and myeloid (42%) diseases participated in 149 values discussions. Initial discussions averaged 17.7 minutes; subsequent discussions were 13.3 minutes. Most patients were comfortable discussing their values and indicated it was important and helpful for them, as well as beneficial for their caregivers. Patients reported feeling heard and understood by their care team following values discussions. Clinicians were comfortable having the discussions, felt they were beneficial, and indicated learning new information about their patients beyond their diagnosis. Conclusions: Incorporating discussions of patients’ HRVs into routine HSCT care was found to be feasible and acceptable in this pilot study. Feedback from patients and providers was overwhelmingly positive. Based on these results, the program has been refined and expanded to include all patients receiving HSCT and chimeric antigen receptor T cell (CAR-T) therapy, with plans to study the clinical impact of this approach.
KW - Primary palliative care, Health related values
KW - Stem cell transplant
UR - http://www.scopus.com/inward/record.url?scp=85214017816&partnerID=8YFLogxK
U2 - 10.1016/j.jtct.2024.12.009
DO - 10.1016/j.jtct.2024.12.009
M3 - Article
C2 - 39701287
SN - 2666-6375
VL - 31
SP - 107.e1-107.e12
JO - Transplantation and Cellular Therapy
JF - Transplantation and Cellular Therapy
IS - 2
ER -