Health-related values discussions with patients undergoing allogeneic and autologous stem cell transplant: Feasibility and acceptability of an early primary palliative care intervention

Background: Hematopoietic stem cell transplant (HSCT) has curative potential but also relatively high morbidity and mortality. Patients have multidimensional palliative care (PC) needs throughout the transplant process. However, PC is not routinely offered to patients with hematologic malignancies. National guidelines recommend PC concurrent with curative hematologic disease treatment, including HSCT.

Objectives: Our goal was to determine the feasibility and acceptability of incorporating early and ongoing discussions of patients' core health-related values (HRVs) for patients with hematologic malignancies undergoing HSCT.

Study design: We designed and implemented a pilot study evaluating the transplant team's use of a brief, structured guide with eight open-ended questions to support patients' articulation of their HRVs. All English-speaking patients undergoing HSCT from March 2021 to March 2022 in two outpatient HSCT clinics were eligible and offered enrollment. HRV discussions were planned pre-transplant, and then at 5 time points post-transplant (Day 10-14, Day 30, Day 100, 6 months, 1 year). Clinicians and patients were surveyed to assess the feasibility and acceptability of this primary PC intervention.

Results: 31 patients, mostly male (61%) and white (68%), with plasma cell (58%) and myeloid (42%) diseases participated in 149 values discussions. Initial discussions averaged 17.7 minutes; subsequent discussions were 13.3 minutes. Most patients were comfortable discussing their values and indicated it was important and helpful for them, as well as beneficial for their caregivers. Patients reported feeling heard and understood by their care team following values discussions. Clinicians were comfortable having the discussions, felt they were beneficial, and indicated learning new information about their patients beyond their diagnosis.

Conclusions: Incorporating discussions of patients' HRVs into routine HSCT care was found to be feasible and acceptable in this pilot study. Feedback from patients and providers was overwhelmingly positive. Based on these results, the program has been refined and expanded to include all patients receiving HSCT and chimeric antigen receptor T cell (CAR-T) therapy, with plans to study the clinical impact of this approach.