Pretransplant Psychiatric Evaluations - a Survey of NMDP Programs

Background:

Hematopoietic stem cell transplantation (HCT) is a procedure that can inflict significant physical and emotional stress on patients. In particular, the emotional stress may often lead to severe psychiatric debility, which may affect nutrition and physical activity, and may lead to lack of compliance with follow up and medications for GVHD and infection prophylaxis.  At a minimum FACT requires “the Clinical Program shall have access to certified or trained consulting specialists and/or specialist groups from key disciplines who are capable of assisting in the management of patients requiring medical care, including but not limited to Psychiatry. ” Currently our patients may sometimes be evaluated by social work but there is no required psychiatric referral. Referrals/consults are often made if psychiatric issues develop. We wanted to determine what the practice is at other transplant centers. Via QA analysis, our program investigated whether we should institute a requirement for a preBMT psychiatric consultation.

Methods:

NMDP lists 154 programs on its website. 13 programs are non-NMDP programs. Programs were emailed asking if the program required patients see a psychiatrist for evaluation prior to transplant and to reply either “Yes” or “No.”. Not every program had email information provided. Some were called.

Results:

Responses were obtained for 89 of 154 total programs and 2 of 13 non-NMDP programs. 27 NMDP programs require a psychiatrist/ologist to see patients prior to transplant.  7 such programs are for children.  19 NMDP programs indicate they do not require a psychiatric evaluation.  19 NMDP programs indicate patients are seen by social work who then determines if a psychiatric evaluation is needed (gatekeeper). 12 NMDP programs indicate that patients are seen by social work but did not indicate whether social work was a ”gatekeeper.” 2 NMDP programs attempted pre-BMT visits with psychiatry/ology but without requirement. 6 programs indicate psychologic support for patients who need intervention or insurance required. 2 programs indicate social work or psychiatry evaluate patients. 2 of 13 programs listed as non-NMDP programs responded. 2 NMDP programs said they were looking into mandatory pre-BMT psychiatric evaluations.

Conclusion:

A high proportion of programs require pre-BMT psychiatric evaluations.  Stress from transplant and resultant psychiatric manifestations may lead to poor patient compliance for follow up, failure to take medications properly, and, rarely, substance abuse. What do other programs do and require? To increase the yield of responses we made this a simple “yes” or “no” questionnaire yet additional information was usually offered. Many programs declared their interest in the results of this survey. We will follow up with programs that did require a psychiatric evaluation preBMT to determine if this has made a qualitative difference in patient care.