Utilizing A Palliative Care Needs Assessment For Adult Allogeneic Hematopoeitic Stem Cell Transplants

Background: Approximately 1.4 million individuals in the United States are diagnosed with hematological malignancies. Due to the complex nature of these conditions, patients often require intensive therapies like hematopoietic stem cell transplants (HSCTs). While HSCTs have curative potential, they also entail significant morbidity and mortality risks. Palliative care can enhance patient outcomes but is underutilized. There is a pressing need to better identify the timing and severity of unmet palliative care needs from the perspectives of patients and clinicians. Methods: This quality improvement project aims to use an evidence-based palliative care outcome scale to assess the needs of adult allogeneic HSCT recipients at an academic medical center in the southeastern United States. Adult allogeneic HSCT recipients and clinicians were surveyed every seven days using the Integrated Palliative Care Outcome Scale (IPOS) to evaluate patient needs across four palliative care domains. The surveys assessed patients’ and clinicians’ previous experiences with palliative care, perspectives of patients and clinicians, and demographic information for both groups. IPOS scores and demographic data were compared between patients and clinicians. Results: This program included 16 enrolled patient participants and nine clinicians over a 10-week survey period. Findings indicated significant IPOS disparities in the physical scores (p = 0.0004), specifically regarding weakness and lack of energy, constipation, drowsiness, and poor mobility symptoms. The emotional/spiritual item “Do you feel at peace?” also yielded statistically significant differences amongst the two groups (p = 0.0042). Qualitative analysis revealed that patients and clinicians prioritize different aspects of clinical care, and that clinicians are divided on the presence of unmet PC needs (N = 4, 44% versus N = 4, 44%). Conclusion: Findings highlight a critical gap between patient-reported needs and clinician perceptions of palliative care timing and appropriateness in HSCT. Routine assessments could foster timely and targeted interventions while improving patient experience, health outcomes, and overall satisfaction with care.