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


Authors: Cohen, A. G.; Cho, C.; Patterson, E.; Magaldi, J.; Doga, T.; Naputo, K.; Alvarez, K.; Giles, E.; Yang, G.; Hoque, A.; Kramer, D.; Devlin, S.; Nemirovsky, D.; Rosa, W. E.; Goldberg, J. I.; Perales, M. A.; Epstein, A. S.; Nelson, J. E.; Landau, H.
Article Title: Health-related values discussions with patients undergoing allogeneic and autologous stem cell transplant: Feasibility and acceptability of an early primary palliative care intervention
Abstract: 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 pretransplant, 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. © 2024 The American Society for Transplantation and Cellular Therapy
Keywords: adult; clinical article; controlled study; aged; middle aged; transplantation, homologous; follow up; palliative care; multiple myeloma; palliative therapy; stem cell transplant; hematopoietic stem cell transplantation; questionnaire; patient participation; hematologic malignancy; myelodysplastic syndrome; hematologic neoplasms; feasibility study; pilot study; feasibility studies; pilot projects; total quality management; physician; allogeneic hematopoietic stem cell transplantation; health belief; caregiver; transplantation, autologous; therapy; autologous hematopoietic stem cell transplantation; allotransplantation; myeloproliferative neoplasm; hematologic disease; caucasian; patient preference; asian; nurse practitioner; autotransplantation; telemedicine; nurse; acute myeloid leukemia; conversation; humans; human; male; female; article; black person; telephone interview; face-to-face interview; primary palliative care, health related values
Journal Title: Transplantation and Cellular Therapy
Volume: 31
Issue: 2
ISSN: 2666-6375
Publisher: Elsevier Inc.  
Date Published: 2025-02-01
Start Page: 107.e1
End Page: 107.e12
Language: English
DOI: 10.1016/j.jtct.2024.12.009
PUBMED: 39701287
PROVIDER: scopus
PMCID: PMC11792765
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Abigail G. Cohen -- Source: Scopus
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MSK Authors
  1. Andrew Saul Epstein
    157 Epstein
  2. Miguel-Angel Perales
    915 Perales
  3. Heather Jolie Landau
    419 Landau
  4. Abigail Gross Cohen
    13 Cohen
  5. Sean McCarthy Devlin
    601 Devlin
  6. Tara Faye Wolff
    5 Wolff
  7. Judith Eve Nelson
    89 Nelson
  8. William   Rosa
    201 Rosa
  9. Kristine Anne Naputo
    32 Naputo
  10. Dana Shulamith Kramer
    14 Kramer
  11. Afshana Ara Hoque
    7 Hoque
  12. Grace Eun-Sun Yang
    1 Yang