The Introduction of a Pre-Admission Psychosocial Assessment Process for Pediatric Allogeneic Stem Cell Transplant Patients and Families

Background

Stem cell transplantation (SCT) is an incredibly stressful and demanding experience for pediatric patients, as well as their family members. Historically, families of pediatric patients undergoing SCT did not meet with the psychosocial team until after admission. As a result, the provision of psychoeducation regarding the manner in which the SCT may psychologically and financially impact the patient and family members is delayed. More specifically, individual, caregiver, or family-based interventions to address issues such as procedural anxiety, mood dysregulation associated with diagnosis and treatment, and significant stress related to treatment decision-making are unavailable to families prior to their inpatient admission.     

Aim

This quality improvement project proposed the introduction of a standardized pre-admission psychosocial assessment for pediatric stem cell transplant families.   

Goals

The psychosocial assessment process will be more efficient

The SCT care team will acquire information about each family’s individualized psychosocial needs earlier

Emotional and resource related support will be available to patients and families earlier, which will allow for the provision of support around pre-admission stressors and more preparation for post-admission stressors

Patient population

Allogeneic stem cell transplant patients referred from outside institutions

Patients receiving stem cell transplantation for metabolic diseases

Patients receiving gene therapy

 Interventions

• Pediatric SCT clinicians and staff were surveyed on their thoughts towards pre-admission psychosocial assessments
• Project leaders met with SCT patient coordinators to define patient selection criteria and develop the scheduling process
• Psychosocial clinician started to attend weekly Patient Review Meeting
• Psychosocial evaluation added to Transplant Pre-Admission Checklist

Conclusions

• Met and exceeded the goal of evaluating 50% of the defined patient population
• Early psychosocial intervention is necessary and valuable
• Continued data gathering is warranted to further assess the effectiveness of the interventions
• Outcome measures are needed to determine the projects impact on patient care

 Next Steps

This project is ongoing at time of submission. The new process will be reviewed at six months and twelve months post implementation.  Stakeholders will be resurveyed to determine the necessity and value of a pre-admission psychosocial assessment. Outcome measures will be developed to determine overall patient satisfaction. Monitoring of clinician and coordinator burden will continue. We are currently surveying other SCT programs on psychosocial services offered; we have contacted 89 centers and have a 17% response rate to date. By one year post implementation we hope to offer a pre-admission psychosocial evaluation to the entire pediatric SCT population.