Advance Care Planning and Palliative Care Integration for Patients Undergoing Hematopoietic Stem-Cell Transplantation

Area of Science:

• Hematology
• Oncology
• Palliative Care

Background:

• Advance care planning (ACP) in hematopoietic stem-cell transplantation (HSCT) is complex due to the potential for cure alongside significant morbidity and mortality risks.
• Integrating palliative care (PC) is essential for managing complex symptoms and improving quality of life in HSCT patients.

Purpose of the Study:

• To evaluate the integration of advance care planning and palliative care for patients undergoing hematopoietic stem-cell transplantation.
• To assess the documentation of code status, advance directives, and utilization of PC and hospice services in HSCT patients.

Main Methods:

• Retrospective analysis of electronic medical records for HSCT patients (January 2011-December 2015).
• Exclusion criteria included multiple transplants and age under 18.
• Primary objective: setting and clinician specialty for initial/final code status documentation. Secondary objectives: advance directive/Physician Orders for Life-Sustaining Treatment completion, PC consultation, hospice enrollment, and place of death.

Main Results:

• The study included 602 HSCT patients (39% allogeneic, 61% autologous).
• Code status documentation was high (99.2% initially full code), but outpatient documentation was low (3% initial, 24% final).
• Palliative care consultation occurred in 19% of patients, primarily in-hospital. Advance directive completion was associated with allogeneic transplant type and age. Hospice enrollment was low (15%), with most deaths (85%) occurring in-hospital.

Conclusions:

• This single-center study highlights low outpatient code status documentation and underutilization of palliative care and hospice services among HSCT patients.
• There is a need to improve the integration of advance care planning and palliative care throughout the HSCT journey, particularly in outpatient settings.