Related Experiment Video
Updated: Jul 17, 2026
CRISPR/Cas9 Gene Editing of Hematopoietic Stem and Progenitor Cells for Gene Therapy Applications
Published on: August 9, 2022
Advance care planning in patients undergoing hematopoietic cell transplantation
Steven Joffe1, Michelle M Mello, E Francis Cook
1Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA. steven_joffe@dfci.harvard.edu
Insights
Advance care planning (ACP) is more common in hematopoietic cell transplantation (HCT) patients than the general population, but clinician discussions and documentation remain low. Further enhancement of ACP is needed for these high-risk patients.
Area of Science:
- Hematology
- Oncology
- Palliative Care
Background:
- Hematopoietic cell transplantation (HCT) involves significant risks, including decisional incapacity and mortality.
- Limited data exist on the prevalence of advance care planning (ACP) among HCT patients.
Purpose of the Study:
- To assess the prevalence of various advance care planning (ACP) elements in adult patients undergoing hematopoietic cell transplantation (HCT).
- To evaluate the documentation of ACP discussions and advance directives in HCT patient medical records.
Main Methods:
- A survey was administered to adult patients pre-HCT to determine completion of ACP elements.
- Medical records were reviewed for documentation of ACP discussions and written advance directives.
- 155 surveys (46% response rate) and 137 medical records were analyzed.
Main Results:
- 69% had a healthcare proxy, 44% a living will, 61% an estate will, and 63% discussed life support wishes with family.
- Only 16% discussed life support wishes with clinicians; documentation of ACP discussions was rare.
- Written advance directives were found in 39% of charts; ACP was more common in older, college-educated, and allogeneic transplant recipients.
Conclusions:
- While ACP prevalence is higher in HCT patients than the general population, significant opportunities exist for improvement.
- Enhancing ACP discussions between HCT patients and clinicians is crucial.
- Further integration of ACP into HCT care pathways is recommended.
Abstract:
Few data are available on the prevalence of advance care planning (ACP) in patients undergoing hematopoietic cell transplantation (HCT). We surveyed adult patients pre-HCT to ascertain completion of various elements of ACP. We also reviewed medical records for documentation of discussions regarding ACP and for the presence of written advance directives. Evaluable surveys were returned by 155 of 335 patients (46%) who underwent HCT during the study period; we obtained permission for medical record review from 137 of these 155 survey respondents (88%). We found that 69% of the respondents reported having designated a health care proxy, 44% had completed a living will, 61% had prepared an estate will, and 63% had discussed their wishes regarding life support with family and friends. In contrast, only 16% had discussed their wishes regarding life support with their clinicians. Documentation of discussions between clinicians and patients regarding most elements of ACP was rare. Written advance directives were present in the charts of 54 patients (39%). ACP was more common in older, college-educated, and allogeneic transplant patients. Even though ACP was more prevalent among this sample than in the general population, its use still could be enhanced, given the high risks of decisional incapacity and death that HCT patients face.
Related Concept Videos
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy the...
01:21Stem Cell Therapy for Tissue Regeneration
Types of Stem Cells used in Stem Cell Therapy
The two main cell types that...
01:21Planning Nursing Care I
01:01Regulation of Hematopoietic Stem Cells
01:16Kidney Transplant III: Nursing Management
01:21Lineage Commitment