Advance care planning and palliative care integration for patients undergoinghematopoietic stem-cell transplantation

Winnie S. Wang, Joseph D. Ma, Sandahl H. Nelson, Carolyn Revta, Gary T. Buckholz, Carolyn M. Mulroney, Eric J. Roeland

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Purpose Advance care planning (ACP) in hematopoietic stem-cell transplantation (HSCT) is challenging, given the potential for cure despite increased morbidity and mortality risk.The aim of this study was to evaluate ACP and palliative care (PC) integration for patients who underwent HSCT. Methods A retrospective analysis was conducted and data were extracted from electronic medical records of patients who underwent HSCT between January 2011 and December 2015. Patients who received more than one transplant and who were younger than 18 years of age were excluded. The primary objective was to determine the setting and specialty of the clinician who documented the initial and final code status. Secondary objectives included evaluation of advance directive and/or completion of the Physician Orders for Life- Sustaining Treatment form, PC consultation, hospice enrollment, and location of death. Results The study sample comprised 39% (n = 235) allogeneic and 61% (n = 367) autologous HSCTs. All patients except one (n = 601) had code status documentation, and 99.2% (n = 596) were initially documented as full code. Initial and final code status documentation in the outpatient setting was 3% (n = 17) and 24% (n = 143), respectively. PC consultation occurred for 19% (n = 114) of HSCT patients, with 83% (n = 95) occurring in the hospital. Allogeneic transplant type and age were significantly associated with greater rates of advance directive and/or Physician Orders for Life-Sustaining Treatment completion. Most patients (85%, n = 99) died in the hospital, and few were enrolled in hospice (15%, n = 17). Conclusion To our knowledge, this is the largest single-center study of ACP and PC integration for patients who underwent HSCT. Code status documentation in the outpatient setting was low, as well as utilization of PC and hospice services.

Original languageEnglish (US)
Pages (from-to)e721-e728
JournalJournal of Oncology Practice
Volume13
Issue number9
DOIs
StatePublished - Sep 1 2017

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Advance Care Planning
Stem Cell Transplantation
Palliative Care
Hematopoietic Stem Cell Transplantation
Hospices
Documentation
Advance Directives
Outpatients
Referral and Consultation
Physicians
Transplants
Electronic Health Records
Morbidity
Mortality
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

Advance care planning and palliative care integration for patients undergoinghematopoietic stem-cell transplantation. / Wang, Winnie S.; Ma, Joseph D.; Nelson, Sandahl H.; Revta, Carolyn; Buckholz, Gary T.; Mulroney, Carolyn M.; Roeland, Eric J.

In: Journal of Oncology Practice, Vol. 13, No. 9, 01.09.2017, p. e721-e728.

Research output: Contribution to journalArticle

Wang, Winnie S. ; Ma, Joseph D. ; Nelson, Sandahl H. ; Revta, Carolyn ; Buckholz, Gary T. ; Mulroney, Carolyn M. ; Roeland, Eric J. / Advance care planning and palliative care integration for patients undergoinghematopoietic stem-cell transplantation. In: Journal of Oncology Practice. 2017 ; Vol. 13, No. 9. pp. e721-e728.
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abstract = "Purpose Advance care planning (ACP) in hematopoietic stem-cell transplantation (HSCT) is challenging, given the potential for cure despite increased morbidity and mortality risk.The aim of this study was to evaluate ACP and palliative care (PC) integration for patients who underwent HSCT. Methods A retrospective analysis was conducted and data were extracted from electronic medical records of patients who underwent HSCT between January 2011 and December 2015. Patients who received more than one transplant and who were younger than 18 years of age were excluded. The primary objective was to determine the setting and specialty of the clinician who documented the initial and final code status. Secondary objectives included evaluation of advance directive and/or completion of the Physician Orders for Life- Sustaining Treatment form, PC consultation, hospice enrollment, and location of death. Results The study sample comprised 39{\%} (n = 235) allogeneic and 61{\%} (n = 367) autologous HSCTs. All patients except one (n = 601) had code status documentation, and 99.2{\%} (n = 596) were initially documented as full code. Initial and final code status documentation in the outpatient setting was 3{\%} (n = 17) and 24{\%} (n = 143), respectively. PC consultation occurred for 19{\%} (n = 114) of HSCT patients, with 83{\%} (n = 95) occurring in the hospital. Allogeneic transplant type and age were significantly associated with greater rates of advance directive and/or Physician Orders for Life-Sustaining Treatment completion. Most patients (85{\%}, n = 99) died in the hospital, and few were enrolled in hospice (15{\%}, n = 17). Conclusion To our knowledge, this is the largest single-center study of ACP and PC integration for patients who underwent HSCT. Code status documentation in the outpatient setting was low, as well as utilization of PC and hospice services.",
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