Publication Date

4-2024

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Abstract

Background: Palliative care facilitates communication, helps with physical and psychological symptom management, and assists in goals of care and advance care planning discussions.1 Multiple organizations, including the American Academy of Pediatrics and American Society of Clinical Oncology encourage palliative care engagement and their involvement with hematopoietic stem cell transplant (HSCT) patients has been shown to be beneficial as HSCT is associated with a high degree of morbidity and possible mortality.2-3 Objective: To increase the number of PaCT consults for patients receiving HSCT for our targeted diagnoses from 48% to 75% by December 2023. Methods: Chart review was conducted for patients who underwent HSCT from July 2020 to July 2022. Demographics documented included reason for and date of HSCT, date of PaCT consult and living status. A targeted diagnosis list was compiled based on which patients were felt to benefit most from palliative care involvement: relapsed or refractory leukemias and lymphomas, myelodysplastic syndrome, high risk myeloid leukemias and metabolic disorders, such as Hurler syndrome. The first plan-do-study-act (PDSA) cycle included discussion of the project at division meetings and education regarding palliative care and evidence of its involvement in HSCT patients. The second PDSA cycle involved revision of the HSCT referral form to include the question “Is PaCT consulted.” During this time, PaCT also started attending the weekly transplant team meetings to discuss current and upcoming patients. Results: Baseline data from July 2020 to July 2022 revealed 48 patients underwent HSCT, 25 of whom had a targeted diagnosis. PaCT met 12 of the 25 patients (48%). From the initiation of the project on 1/1/23 to 11/30/23, 14 patients with a targeted diagnosis underwent HSCT. Eight of the 14 patients (57%) received a PaCT consult. Conclusions: Palliative care involvement in pediatric oncology is well established, but its role in HSCT patients continues to be explored. As HSCT patients receive more intense therapy, have frequent deaths in intensive care units and can have limited opportunity for end of life planning due to rapidly changing clinical courses, early integration of PaCT could allow for decreased symptom burden and distress for both patients and families.4 Future PDSA cycles to further increase involvement include adding PaCT consultation to the transplant evaluation order set in the electronic medical record and review of the comments on the completed HSCT referral forms to identify possible barriers in the PaCT consultation process.

Disciplines

Oncology | Palliative Care | Pediatrics

Notes

Presented at the 2024 American Society of Pediatric Hematology/Oncology (ASPHO) Conference; April 2-5, 2024; Seattle, WA.

Increasing Palliative Care Team Involvement in Pediatric Hematopoietic Stem Cell Transplant Patients

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