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

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

Kent L; Williams M; Pinner LA; Callard E; Fisher J; Pyke-Grimm K

Transplantation and Cellular Therapy

2023

distress syndrome; hematopoietic stem cell; palliative therapy; transplantation; child; conference abstract; consultation; controlled study; evidence based practice center; female; Hematopoietic Stem Cells; human; human cell; learning; major clinical study; male; medical record review; morbidity; mortality; Palliative Care; retrospective study; risk assessment; satisfaction; staff training; Stem Cell Transplantation

Topic significance and study purpose/background/rationale: Patients undergoing hematopoietic stem cell transplant (HSCT) are at risk for significant morbidity and mortality and experience distressing psychological and physical symptoms. Access to palliative care services early in the treatment course can mitigate psychological suffering, address physical symptoms, and establish rapport with the palliative care team. There is no standardized practice for palliative care consultations for these patients. The aim of this evidence-based practice project was to determine if the early implementation of a palliative care trigger tool increases the number of palliative care consults in this population. Methods, intervention, and analysis: A pre-intervention survey was administered to assess staff understanding and satisfaction with palliative care services. A retrospective chart review was conducted to determine patients at highest risk for morbidity and mortality from HSCT. A paper trigger tool was developed to identify patients considered highest risk in order to place a palliative care consultation prior to or on admission for HSCT. Implementation included staff education via various medias. The trigger tool was implemented over a 6-month period on a 24 bed HSCT Unit. Findings and interpretation: The staff pre-survey demonstrated support for the project with 79% being very or extremely interested in learning more about palliative care. Additionally, 60% disagreed or strongly disagreed that palliative care services were introduced early enough. Based on a two and a half year retrospective chart review, 51 patients met criteria for early integration of palliative care services and 15 received consultations. To date, the trigger tool has been used on 14 patients and has resulted in early consultation in 11 patients. Discussion and implications: Based on the trigger tool, most patients admitted for HSCT qualify for early integration of palliative care services. The tool effectively identified patients for early integration of palliative care services. Providing early palliative care is an important priority of care for patients undergoing HSCT.Copyright © 2023 American Society for Transplantation and Cellular Therapy

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