Post AHSCT Palliative Care Survey Shows Patient Needs, Clinician Perceptions Differ

The Integrated Palliative Care Outcome Scale showed the potential to guide palliative care integration to better help patients and clinicians after AHSCT.

Long-term, structured Integrated Palliative Care Outcome Scale (IPOS) assessments before and after allogeneic hematopoietic stem cell transplantation enhanced timely interventions, improved care coordination, and empowered patients to report evolving palliative care needs, according to results from a mixed-methods analysis presented at the 2025 Oncology Nursing Society (ONS) Congress.

The study found that 559 days after transplant, patients had a reported IPOS score of 34 and did not report any main concerns, whereas clinicians had a reported IPOS score of 12 and reported “pneumonia, embolism, and bacterium” as the main concerns. At 1448 days after transplant, patients had an IPOS score of 35 and reported “when will things be done” as a main concern, whereas clinicians had an IPOS score of 13 and reported “acute renal failure, cellulitis/bacteremia, and thrombocytopenia” as main concerns. At 35 days after transplant, patients had an IPOS score of 45 and reported “stumble and fall” as the main concerns, whereas clinicians had an IPOS score of 19 and reported “weakness, fall, diarrhea” as the main concerns.

Per IPOS dimension scores, for Physical, patients had a mean score of 2.08 vs 1.61 with clinicians (P <.05); Emotional/Spiritual scores were 1.44 and 1.84, respectively (P <.05); Practical scores were 1.41 and 1.59; and Psychological scores were 2.11 and 2.32.

“Palliative care is underutilized in transplantation despite its role in promoting quality of life, symptom management, and goal setting,” primary study author Abigail Short, BSN, RN, OCN, from the University of North Carolina (UNC) at Chapel Hill, wrote with coauthors. “Patient-reported needs differed from clinician perceptions regarding palliative care needs during transplantation. Long-term IPOS assessment can inform and guide palliative care integration from the time of hospitalization to post-acute care setting following transplantation.”

Patient data were used if they were hospitalized for allogeneic stem cell transplantation in the Bone Marrow Transplant Unit at UNC Medical Center, and eligibility was confirmed if the patient consented and the charge registered nurse approved. The baseline IPOS assessment and surveys were administered with firewalled iPads; IPOS assessments were repeated every 7 days, new patients completed the demographic questionnaire with the first survey only, administration only occurred while in the bone marrow transplant unit; no additional surveys were given prior to patient discharge if it was before or after the day of survey and patients were re-enrolled if they were readmitted or transferred back to the bone marrow transplant unit.

The study included data from 25 participants, 16 of whom were patients and 9 were clinicians. Regarding patient characteristics, 31% were female and 56% were male, 1 patient was between 18 and 29 years, 1 was between 40 and 49 years, 3 were between 50 to 59 years, 6 were between 60 and 69 years, and 6 were between 70 and 79 years, 81% were White. Also, 56% did not have previous palliative care consultations; of symptoms that would benefit from palliative care, 31% said emotional distress, pain, and poor appetite, 25% said poor mobility, goals of care, and spiritual distress, and 19% said nausea, vomiting, and weakness; and 44% said goals of care were benefitted by palliative care, while 31% said psychosocial and emotional distress and 19% said physical and spiritual distress were perceived palliative care benefits.

Regarding clinicians, 67% were female, 1 was between 18 and 29 years, 6 were between 30 and 39 years, 1 was between 40 and 49 years, and 1 was between 60 and 69 years, 33% were White, 33% were African American, and 22% were Asian. Also, 56% were advanced practice providers, 33% were physician fellows, and 11% were attending physicians; 67% had 0 to 5 years of practice, and 22% had no prior palliative care training.

Regarding individual IPOS items, patients reported an IPOS score of 10 for “overwhelmingly” with weakness or lack of energy and clinicians reported 1 (P = .0075); patients reported 22 and clinicians reported 30 for not having constipation (P = .0319); patients reported 22 and clinicians reported 29 for not having sore or dry mouth (P = .0430); patients reported 12 and clinicians reported 21 for not being drowsy (P = .0035); patients reported 11 and clinicians reported 0 for having “overwhelmingly” poor mobility (P = .0250); and patients reported 19 and clinicians reported 6 for always feeling at peace (P = .0042).

Reference

Short A, Kuroki M, Leak-Bryant A, et al. Integrating palliative care in adults undergoing allogeneic hematopoietic stem cell transplantation: an evidence-based needs assessment for patients and clinicians. Presented at the 2025 Oncology Nursing Society Congress; April 9-13, 2025. Denver CO. Poster RS120.