Perceptions of Proactive Palliative Care Integration Among Pediatric Hematopoietic Cell Transplant Providers: A Pilot Study

Background: Pediatric hematopoietic cell transplantation (HCT) conveys significant risk of mortality, morbidity, impaired quality of life, and multifactorial distress. One potential strategy for improving experience and relieving suffering is proactive specialty palliative care (SPC) utilization. However, SPC is not routinely incorporated into pediatric HCT. One barrier to SPC integration is unknown pediatric HCT provider perceptions of SPC services, particularly among providers with lived experience working within a collaborative HCT-SPC partnership. Objective: This single-institution pilot study aimed to (1) describe an approach to standardized, proactive pediatric HCT-SPC clinical partnership, and (2) quantify acceptability, appropriateness, and satisfaction regarding the program among pediatric HCT providers. Methods: Survey methods were used to assess attitudes among HCT providers who had worked with the SPC clinical partnership for at least three months. Core survey metrics were the validated Acceptability of Intervention Measure and Intervention Appropriateness Measure. Additional survey items were adapted from the Perceptions of Palliative Care Instrument. Results: Respondents reported high mean scores for acceptability (4.96) and appropriateness (4.93) on a 5-point scale. Overall satisfaction with SPC integration averaged 8.72 (SD 1.13) on a 10-point scale. Satisfaction scores for each individual service provided by SPC were similarly high. No significant differences in responses were found based on provider type, prior SPC training, or years in practice. Conclusions: In this single-institution pilot study, pediatric HCT providers with lived experience working in an environment with standardized SPC collaboration view SPC as highly acceptable, appropriate, and beneficial for their patients, supporting the feasibility and value of proactive SPC integration in pediatric HCT care.