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Early Integration of Palliative Care Services in Pediatric Stem Cell Transplant Patients
Laurel Kent1, Molly Williams2, Lisa Pinner3
1Laurel Kent, MSN, FNP, RN , is nurse practitioner, Center for Advanced Practice, Pediatric Stem Cell Transplant, Stanford Medicine Children's Health, Palo Alto, CA.
Insights
A new palliative care trigger tool effectively identified pediatric stem cell transplant patients needing early palliative care services. This tool improved the integration of crucial support, enhancing symptom management and quality of life during treatment.
Area of Science:
- Pediatric Hematology
- Palliative Care Medicine
- Evidence-Based Practice
Background:
- Hematopoietic stem cell transplant (HSCT) patients face significant risks of morbidity and mortality.
- Early integration of palliative care is crucial for managing symptoms and improving quality of life in these patients.
Purpose of the Study:
- To evaluate the impact of a palliative care trigger tool on the number of palliative care consults and early service integration in pediatric HSCT patients.
- To determine the tool's effectiveness in identifying high-risk patients for timely palliative care.
Main Methods:
- Development and implementation of a palliative care trigger tool on a pediatric HSCT unit over 6 months.
- Retrospective chart review to assess patient qualification for and receipt of palliative care services before and after tool implementation.
Main Results:
- Before tool implementation, 35% of patients met criteria for early palliative care, but only 29% received it.
- After implementation, 52% of transplant patients qualified for palliative care, and 80% received it, demonstrating improved service delivery.
Conclusions:
- The palliative care trigger tool is effective in identifying pediatric HSCT patients eligible for early palliative care integration.
- The tool successfully increased the provision of palliative care services to identified high-risk patients, supporting symptom management, quality of life, and decision-making.
Abstract:
Patients undergoing hematopoietic stem cell transplant are at risk for significant morbidity and mortality throughout their treatment course. The aim of this evidence-based practice project was to determine if the use of a palliative care trigger tool impacted the number of palliative care consults and/or the early integration of palliative care services within the pediatric hematopoietic stem cell transplant patient population. A trigger tool was developed to identify patients at highest risk for stem cell transplant-associated morbidity and mortality. It was implemented on a 24-bed pediatric stem cell transplant unit over a 6-month period. Based on a retrospective chart review, 35% of patients met criteria for early integration of palliative care services, while 29% of those who qualified received services. After the implementation of the trigger tool, 27 patients underwent stem cell transplant, and 52% qualified for palliative care integration while it was received by 80%. The tool was determined to be effective in identifying patients for early integration of palliative care services and providing these services to identified patients. Providing early palliative care during stem cell transplant with a focus on symptom management, quality of life, and decision-making is a priority of care for patients undergoing stem cell transplant.
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