CT-019 Patient Perceptions of Palliative Care in the Process of Allogenic Stem Cell Transplantation

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is associated with significant sequalae that affect patients' overall quality of life (QoL). Although studies have shown improvement in patient QoL with the involvement of palliative care in the allo-HSCT process, perceptions regarding palliative care often impact referrals to palliative care. We conducted a study to examine patient perceptions of palliative care during evaluation for allo-HSCT. Primary endpoint was to assess the change in patient pre-and post-questionnaire responses. Secondary endpoint was to assess for completion of advance care planning documentation. We conducted a prospective, single-center study, of adult patients who were referred for palliative care consultation as part of evaluation for allo-HSCT. Patients were administered a pre- and post-visit questionnaire to assess understanding and comfort level with palliative medicine. We enrolled 32 patients (male = 14) patients undergoing evaluation for allo-HSCT with a primary diagnosis of AML (n=8), NHL (n=8), MDS (n=7), ALL (n=2), and other (n=7). Our study showed that the majority (56%) of patients reported a below-average (poor or fair) knowledge of palliative medicine and understanding of the reason for palliative medicine consultation. Following consultation with palliative care there was a statistically significant increase in patient understanding of reason for the appointment, p= 0.0006. There was also a significant increase in patients' knowledge of palliative care, with only 28% describing their knowledge as "good" or "excellent" prior to consultation and 79.3% after consultation, p <0.0001. There was an observed positive trend in patient comfort level with palliative medicine and likelihood to utilize palliative medicine during allo-HSCT following consultation, although not statistically significant. There was a higher rate of completion of advance care planning documentation following consultation with palliative medicine 56.3% vs 71.4%, p= 0.042. The majority of patients undergoing allo-HSCT report a poor understanding of palliative medicine. A palliative care consultation prior to allo-HSCT increases a patient's understanding of the role of palliative medicine in his/her allo-HSCT. A positive trend was observed in patients' comfort with and interest in continuing to utilize palliative medicine following initial consultation.