Palliative Care for the Management of Patients with Allogeneic Hematopoietic Stem-Cell Transplantation: A Cross-Sectional Survey in Comprehensive Cancer Centers

Abstract

Introduction: Specialist palliative care (SPC) is rarely integrated into the management of patients with an allogeneic hematopoietic stem-cell transplantation, despite considerable symptom burden and mortality. We aimed to assess hematologists' and nurses' views on SPC integration.

Methods: Multi-center cross-sectional survey with exploratory character. We asked when to best integrate SPC, with three vignettes of patients with good (90% chance of cure/10% risk of death), "fifty-fifty," or poor (10%/90%) prognosis, and assessed preferences regarding integration models and support. We calculated descriptive statistics and associations with chi2/Fisher's exact tests and non-parametric tests.

Results: There were 80 respondents (56% females; mean age: 36.2 years, SD = 7.7; 47 physicians and 33 nurses; 42 in transplant setting, 28 in general oncology/hematology, 9 in intensive care unit, 1 unknown; mean experience: 6 years, SD = 0-25). Participants, regardless of profession, highly agreed to integrate SPC for patients with poor prognosis (Yes = 96%), but a majority would not do so for good prognosis patients (No = 63%). In "fifty-fifty" prognosis, there was no agreement among physicians, whereas nurses would mostly integrate SPC. The preferred integration model for patients with poor or "fifty-fifty" prognosis was a co-management for specific patients' needs. Participants primarily wanted palliative care specialists to support them in addressing life threat with patients.

Conclusion: This study highlights the need to develop accurate integration criteria of SPC in the transplant trajectory, taking multi-professional perspectives into account.

Keywords: Health care professionals; Hematology; Palliative care; Stem-cell transplantation.