Palliative care for patients around the time of haematopoietic stem cell transplant: a qualitative study of patients’ perceptions and experiences of unmet need and attitudes towards palliative care involvement

• Published in: Supportive care in cancer Vol. 30; no. 3; pp. 2253 - 2261
• Main Authors: Gemmell, Rebecca, Halley, Angela, Stevens, Anna-Marie, Allam, Alison, Perkins, Margaret, Ethell, Mark, Sriskandarajah, Priya, Droney, Joanne
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2022; Springer; Springer Nature B.V
• Subjects: Advance directives; Analysis; Attitude of Health Personnel; Blood cancer; Decision making; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Internet videos; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Palliative Care; Palliative treatment; Patient satisfaction; Qualitative Research; Quality of Life; Rehabilitation Medicine; Stem cell transplantation; Stem cells; Transplantation; Qualitative research; Palliative care; Advance care planning; Haematopoietic stem cell transplantation; Shared; Decision making
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-021-06556-4

Background
Haemato-oncology patients are likely to be referred later to palliative care than patients with solid tumours, despite experiencing similar symptom burden. Patients prior to stem cell transplant may benefit from symptom control, advance care planning and shared decision-making, and previous studies have demonstrated feasibility and benefit of such a service. However, the views of patients are not yet established, and are vital to ensure acceptability of the service.
Aims
To identify areas where a palliative care team may help to support patients being considered for a stem cell transplant, and to explore the attitudes and perceptions of patients towards palliative care at this time.
Design
A qualitative study including interviews (
N
 = 12) and a focus group (
N
 = 4) for patients pre- and post-transplant, using a semi-structured format via telephone, online video-conferencing and face-to-face discussions. Recordings were transcribed and analysed using thematic analysis.
Setting
A tertiary cancer centre in the UK.
Findings
Themes identified were the following: Identified needs, Information and decision-making, Importance of relationships, Changing perceptions of what palliative care means, and The future.
Patients associate palliative care with terminal care due to indirect experiences. Patients were open to palliative care once its purpose was explained and described emotional and physical needs relevant to early palliative care.
Conclusions
The involvement of early palliative care alongside haematology treatment prior to stem cell transplant may improve quality of life for patients and facilitate shared decision-making at a crucial stage of treatment. Early palliative care should be offered alongside haematology care around the time of stem cell transplant, with information provided to patients regarding its role.