Early and Systematic Involvement of Palliative Medicine Team During Bone Marrow Transplant Improved Patient Care, QOL, and Patient and Caregiver Satisfaction

Bone marrow transplant (BMT) is potentially curative for patients with incurable cancers but is associated with considerable morbidity and mortality. Early intervention by palliative medicine in patients with terminal cancers has been shown to improve patient quality of life (QOL). However, its role in BMT has not been well studied. There is concern that early introduction of palliative medicine may be negatively perceived by patients. We formed a multidisciplinary team combining BMT and palliative medicine physicians to co-manage patients throughout the BMT process. We studied the effects of this model of care on patient symptoms during/after transplant and improvement of patient/caregiver QOL. From March 1, 2014 to May 1, 2015 all allogeneic BMT patients were evaluated by palliative medicine at initial BMT consult, transplant admission, readmissions for transplant complications, and at patient/caregiver request to assess patient/caregiver needs, provide counselling and treatment recommendations. These consultations focused on goals of care, advanced directives, and coping during the BMT process. The program impact was assessed by IRB approved patient/caregiver 5 point Likert-scaled surveys regarding symptom control (nausea, diarrhea, appetite, fatigue) and QOL in populations before (2013-mailed) and after program implementation (2014-15-in BMT clinic). Patients and caregivers completed surveys separately. See Table 1. Survey response rates were 24% and 20% for patients and caregivers in 2013 respectively and 47% for both patients/caregivers in 2014-15. The small study populations precluded statistical analysis. Patient QOL remained stable. All other qualitatively assessed surveyed metrics of patient/caregiver support receiving a score of 4 to 5 (highest rating, scale 1-5) improved during program implementation. Completion of advanced directives increased from 62% (n=13) in 2013 to 75% (n=29) in 2014-15. Our multidisciplinary BMT and palliative medicine team was well received by patients and caregivers. Inclusion of palliative medicine in the BMT care team did not decrease patient/caregiver decisions to proceed with transplant. Patients and caregivers reported improved communication with their care team, symptom management, and emotional support. Recognizing a need for increased counseling and emotional support by survey results we created a new patient/caregiver support group. These results highlight the benefits of early integration of palliative medicine with BMT programs.Table 1Patient ScoresCaregiver ScoresPre- implementation(n=4)Post- implementation(n=24)Pre-Implementation(n=5)Post-Implementation(n=20)Communication83.3%98.4%80%94.6%Symptom management70.8%84.4%75.9%85.9%Emotional support66.7%93.4%71.4%77.8%QOL80%80.8%71.4%80.8%Would you do BMT again?83.3%93.1%62.5%100% Open table in a new tab