Palliative care in hematologic oncology: A needs assessment.

Abstract

137 Background: As patients with hematologic malignancies further enter the scope of practice for palliative medicine physicians, it is important to have an accurate view of their needs. Historically, there is a paucity of research examining symptom burden in this cohort. Even fewer studies explore the experience and perceptions of frontline hematology providers. As our Geriatrics and Palliative Medicine team at North Shore University Hospital (NSUH) embarked upon a collaborative Supportive Care model on our hospital’s dedicated Leukemia and Bone Marrow units, it was important to gain insight from providers about this population. Methods: We conducted a supportive care needs assessment survey of the staff (faculty, fellows, nurse practitioners, nurses, social workers, and case management) from the Leukemia and Bone Marrow units. The survey encompassed eighteen domains and attempted to assess their prevalence in patients according to the Hematology team. It included symptom burden, social and functional complexities, advance care planning, and goals of care. Free text responses were used to capture staff input about challenges in caring for this population Results: We received a response rate of 30% (30/101) with respondents primarily being nurses. It revealed the domains most commonly seen in this patient population by the team. Domains selected as “frequently” or “almost always” were fatigue (97%), nutritional issues (96%), gastrointestinal issues (93%), anxiety (80%), goals of care (69%), and advance directives (69%). We learned that symptom management was a challenge for the staff. They expressed that patients’ expectations about the impact of chemotherapy is a key area of importance. Lastly, communication with patients throughout treatment and caregiver support were consistent concerns from the team. Conclusions: Determining the four most prominent issues encountered by hematology staff were fatigue, nutritional, gastrointestinal, and anxiety can help to refine the symptom assessment. Moreover, communication and decision making concerns were important. These results underscore the necessity of assessing provider perspectives while treating those with hematologic malignancies to guide future initiatives.