Early Integration of Palliative Care Services in Pediatric Stem Cell Transplant Patients

Patients undergoing hematopoietic stem cell transplant are at risk for significant morbidity and mortality throughout their treatment course. The aim of this evidence-based practice project was to determine if the use of a palliative care trigger tool impacted the number of palliative care consults and/or the early integration of palliative care services within the pediatric hematopoietic stem cell transplant patient population. A trigger tool was developed to identify patients at highest risk for stem cell transplant-associated morbidity and mortality. It was implemented on a 24-bed pediatric stem cell transplant unit over a 6-month period. Based on a retrospective chart review, 35% of patients met criteria for early integration of palliative care services, while 29% of those who qualified received services. After the implementation of the trigger tool, 27 patients underwent stem cell transplant, and 52% qualified for palliative care integration while it was received by 80%. The tool was determined to be effective in identifying patients for early integration of palliative care services and providing these services to identified patients. Providing early palliative care during stem cell transplant with a focus on symptom management, quality of life, and decision-making is a priority of care for patients undergoing stem cell transplant.