CN28 Impact of serious illness care program to patients with hematopoietic stem cell transplantation on goals of care documentation and acute healthcare utilization

Abstract

We designed a multicomponent intervention, the Serious Illness Care Programme (SICP), to improve serious illness conversations and care for patients with hematopoietic stem cell transplantation with palliative care needs. We implemented the SICP in our transplant center to determine if the effects of this program could be translated to this group of patients. Inpatient care setting implemented the SICP, each over 3-4 sessions. Patients were identified based on an answer of “no” to the question “would I be surprised if this patient died within the next year?”, or any patient with significant symptom scores or depression/ anxiety scores of >4 not respond to conventional care. Our nurses were trained in the SICP conversation. A maximum of 2 patients per week were identified and prepared to have the SICP conversation. Rates of documentation on our system’s advance care planning and goals of care (GOC) were recorded. Patient satisfaction was also assessed. Acute admission rate was compared between the SICP and control groups by t test. 31 patients were identified. Three patients were lost to follow-up. Of the remaining patients who had the SICP conversation, 25 (89 %) had documentation on the hospital electronic record. This was a major improvement over baseline rates of documentation (<30%). 26(93%) had high satisfaction for the program. Compared with control, the SICP group had significant reduction in unplanned acute admissions in last 90 days (3.2 vs 2.5, p=0.015). SICP implementation resulted in high rates of documentation of goals and preferences. Patients had high satisfaction level. There were significant reduction in acute health use when compared with the control group.