Early Intervention with HSCT Patients to Improve Access to and Knowledge of Palliative Care

Topic Significance & Study Purpose/Background/Rationale

Our purpose was to formally initiate palliative care services early (prior to admission) for Hematopoietic Stem Cell Transplant (HSCT) patients thereby improving access and knowledge for patients and their families throughout all hospitalizations.  Physicians, nurses and patients/families struggle regarding issues related to palliative care.  Statistics indicate that some HSCT patients have only a 15-45% survival rate at five years, therefore, could use the extra support.   A practice gap existed between our practice for HSCT patients regarding palliative care and the recommended evidenced-based guidelines from the National Comprehensive Cancer Network (NCCN).  The characteristics from NCCN that qualify patients for palliative care are indicative of many patients who are hospitalized for transplant.

Methods, Intervention, & Analysis  

The palliative care team facilitated two meetings for the patients.  Meeting #1 was outpatient prior to admission with a focus on information. Meeting #2 was inpatient approximately eight days post stem cell transplant with a focus on individualizing the plan of care for the patient.  Interventions provided by palliative care included:  Advanced Care Navigation – “preparedness planning” and consistent supportive communication.  Discussion topics included: patient values and hopes, what is meaningful to them, collaboration about goals of care, and anticipatory guidance. A patient questionnaire was completed by the patient after the completion of meeting #2. An exit interview with the palliative care team at the conclusion of the study was used to gather reflections which are included in the results.

Findings & Interpretation

Data collection occurred over a period of 17 months, with a total of 25 patients to complete the study. 92% of the patients felt they had the information needed to access palliative care. 84% of the patients reported an increase in knowledge about palliative care.

Discussion & Implications

Data indicates that there was an increased knowledge and understanding of palliative care, and an improved ability to access palliative care.  Although the benefit of early palliative care is clear in the literature, anecdotal results reveal it is difficult to know when the patients will be emotionally and intellectually most ready to learn.