Pre-Transplant Psychosocial Assessment Practices: A National Survey of Transplant Centers

Abstract

Background Hematopoietic cell transplant (HCT) is psychologically and socially demanding of patients. As such, they typically undergo psychosocial assessment pre-HCT to identify high risk factors that require intervention before, or close monitoring throughout transplant. Despite consensus that the assessment is a valuable component of the pre-HCT evaluation, there is a lack of evidence-based guidelines for it. This has led to practice variation among centers and fragmented psychosocial data that limit research. The objective of this study was to describe the content (what is assessed) and the process (who is assessed, by whom, when, and how) of the pre-HCT psychosocial assessment at U.S. transplant centers. Methods A survey was conducted with professionals who conduct pre-HCT psychosocial assessments with adult patients. The researchers developed and pre-tested a 22-item questionnaire with input from social workers. The questionnaire included transplant center characteristics, assessment items including standardized measures, and procedural aspects i.e. how high risk factors are handled. Results Of 139 eligible transplant centers, 92 (66%) had a psychosocial professional respond. The number of autologous transplants performed annually ranged from 15-300 and the number of allogeneic transplants ranged from 5-247. Approximately 81% of the centers reported having 1-2 psychosocial professionals who conduct assessments, while the remainder reported having 3-13. These professionals included licensed social workers with a master's degree (78% of centers), psychologists (21%), and psychiatrists (2%). The majority of centers (86%) reported that all patients undergo pre-HCT psychosocial assessment. Of the 3 psychosocial risk rating scales most commonly applied to HCT candidates, the Stanford Integrated Psychosocial Assessment for Transplantation was used most frequently (10 centers), followed by the Psychosocial Assessment of Candidates for Transplantation (5), and Transplant Evaluation Rating Scale (4). Of the many psychometric measures reported, the Patient Health Questionnaire-9 was used most frequently (20 centers). The majority (63%) reported that the assessment is considered most or all of the time when determining HCT eligibility. The majority (86%) also reported that patients have been declined for HCT based on psychosocial reasons such as active substance use, untreated mental illness, and no caregiver. Conclusion Pre-HCT psychosocial assessment practice varies among centers, particularly in standardized and psychometric measures used. Study results are being used to inform the development of an evidence-based assessment tool that would produce standardized, high-quality psychosocial data. The finding that one-third reported the assessment was not considered most of the time in determining HCT eligibility needs to be further studied.