Retrospective Assessment of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in Hemotopoietic Stem Cell Transplantation (HCT) Recipients

Background: HCT is a lengthy, complex procedure with the potential for decreased quality of life, transplant related mortality, relapsed disease, and graft-versus-host disease. Psychosocial assessments are a part of the overall HCT evaluation process, but there are very few validated psychosocial instruments for this patient population. Recently, the SIPAT has been shown to predict outcomes in solid organ transplantation. A retrospective pilot study was performed on 25 consecutive HCT patients to investigate whether SIPAT results correlated with HCT outcomes.

Methods: The retrospective pilot study was modeled after methodology published in any earlier SIPAT study conducted by JR Maldonado (Psychosomatics, 2012). Two experienced HCT reviewers, a physician and a social worker, and an inexperienced reviewer, a transplant coordinator, conducted the retrospective chart review, completing the SIPAT for 25 consecutive HCT recipients at the University of Virginia between January and October 2012. A clinical research coordinator independently reviewed each patient’s medical records and interviewed transplant coordinators to record HCT recipient outcomes.

Results: HCT recipients (median age 52, 56% male) received HCT’s for myeloma, lymphoma and leukemia. 14 recipients received an allogeneic transplant, while 11 received an autologous one. The inter-rater reliability between the SIPAT reviewers was inconsistent. 2 reviewers correlated well (R=.84), while the other correlations between reviewers were weak (R=.62 and R=.55).  It was noted that there was a response shift in SIPAT reviewer 3 to lower scores, indicating potential bias in reviewers 1 and 2 due to prior patient exposure. To test possible associations of psychosocial assessments with recipient outcomes, individual reviewer SIPAT scores were plotted. These indicated higher assessment scores were associated with poorer social support and compliance, and increased drug relapses, and psychiatric symptoms. Other outcome measures such as graft failure, treatment related mortality, re-hospitalization and disease relapse failed to show a relationship with SIPAT scores.

Conclusion: SIPAT scores may indicate positive relationships between HCT psychosocial assessments and various psychosocial outcomes. Due to the limited number of transplant recipients in the retrospective review, it was not possible to completely blind the experienced reviewers. Bias may have been introduced resulting in higher scores for these reviewers compared to the third reviewer, who was new to the program. Additionally, the poor inter-rater reliability of the SIPAT (in spite of education and practice) may have arisen from the challenges of scoring patients retrospectively through chart reviews, as the program’s psychosocial assessment was not as detailed as the SIPAT. These issues can be addressed in future prospective studies.